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[IN] MTC HEA
TO HEALTH, MEDICAL, AND NATIONAL EDITORS:
Ambulatory Surgical Facilities in Northeast Pennsylvania Collaborate
with the Pennsylvania Patient Safety Authority to Reduce
Day-of-Surgery (DOS) Cancellations
HARRISBURG, Pa., March 6, 2014 /PRNewswire-USNewswire/ --Ambulatory
surgical facilities (ASFs) in northeast Pennsylvania collaborated with
the Pennsylvania Patient Safety Authority and implemented protocols,
like a nurse-driven preoperative screening and assessment, for
reducing day-of-surgery (DOS) cancellations, according to an article
from the March Pennsylvania Patient Safety Advisory released today.
A nurse-driven preoperative screening and assessment is a separate
clinical evaluation for patients undergoing same-day surgery. This
evaluation of the patient's history and physical, diagnostic tests and
psychosocial information is used to identify the patient's medical,
physical and psychosocial needs and risks for developing complications
or requiring cancellation of same-day surgery.
"Ambulatory surgical facilities are not required to use nurse-driven
preoperative screenings and assessments, however our collaboration
shows that by implementing them and some other protocols
day-of-surgery cancellations can be reduced," Lea Anne Gardner, PhD,
RN, senior patient safety analyst for the Pennsylvania Patient Safety
Authority said. "A standardized checklist and initiating a second
preoperative patient phone call were some other helpful interventions
used during the collaboration."
From January 2012 through June 2013, the Authority conducted an
18-month collaborative improvement project with 11 ASFs in the
northeast region of Pennsylvania.
"The project focused on day-of-surgery cancellations because
preoperative screening on the day-of-surgery is the last opportunity
to catch medical conditions that would place patients at risk for
complication and rearranging schedules due to last-minute
cancellations which creates opportunities for mix-ups with patient
names, procedures or medications," Gardner said. "The goal of this
collaboration was to reduce patient day-of-surgery cancellations by 30
percent and transfers to acute care hospitals by 25 percent."
The collaboration had three phases: the planning phase (January 6,
2012 through June 30, 2012) focused on standardizing definitions for
cancellations and transfers; the preintervention phase (July 1, 2012
through November 30, 2012) where facilities implemented the
cancellation and transfer event investigation forms; and the
postintervention phase (December 1, 2012 through June 30, 2013) which
began with implementation of the standardized preoperative checklist.
During the last phase two additional interventions were introduced to
the ASFs: 1) initiating a second patient preoperative phone call and
incorporating health literacy strategies into patient-staff
interactions (e.g., teach-back method, phrasing of questions) and
patient-friendly preoperative forms. A third intervention, done by the
Authority, was a health literacy conference call which gave ASFs
strategies to avoid miscommunication and confusion with the patient by
not using medical jargon etc.
"No-show cancellation rates were 120 percent higher in patients who
did not have a preoperative screening and assessment done compared to
patients who were screened preoperatively during the postintervention
period," Gardner said. "Transportation-related and protocol-related
day-of-surgery cancellations decreased by 28.5 percent and 22.4
percent, respectively, in patients who received a preoperative
screening and assessment using a standardized checklist."
A DOS cancellation was defined as a cancellation of a scheduled
procedure or surgery that occurred after 12:01 a.m. on the DOS for any
reason. DOS cancellations occurred prior to admission, after admission
and after anesthesia.
The ASFs achieved a 9.7 percent reduction in their DOS cancellation
rate, from 29.6 DOS cancellations per 1,000 completed procedures
preintervention to 26.8 DOS cancellations per 1,000 completed
Gardner said a closer look at patients without a preoperative
screening showed a greater percentage of no-show cancellations.
"No shows on the day-of-surgery drop 10 to 15 percent if a
preoperative screening and assessment is performed. That number
increases 30 to 50 percent if a preoperative screening and assessment
is not done prior to the day of surgery," Gardner added. "Selecting
appropriate patients for same-day-surgery through the implementation
of these interventions can improve patient safety by identifying
patients suited for outpatient surgery or procedures, reduce
disruptions or delays in the surgery schedule and increase patient
For more information about the ASF collaboration go to the March
Pennsylvania Patient Safety Advisory article, "Preoperative Screening
and the Influence on Cancellations and Transfers: An Ambulatory
Surgical Facility Collaboration" at www.patientsafetyauthority.org.
The interventions used during the collaborative are also available on
the Authority's website under "educational tools."
The Authority's 2014 March Advisory contains other clinical articles
with toolkits for the healthcare provider to improve patient safety.
This year marks the 10th Anniversary since the first Patient Safety
Advisory was published in March 2003 during Patient Safety Awareness
Week. Highlights of the 2014 March Advisory include:
-- Aligning the Lines: An Analysis of IV Line Errors : Analysis of
intravenous (IV) line events reported to the Authority showed that
three errors were responsible for nearly 50 percent of the events:
rate of infusion mix-up or line mix-up, IV lines not attached to
patients and errors associated with piggyback infusions. Included with
this article are risk reduction strategies and self-assessment
questions, the latter for internal education.
-- The Use of Patient Sitters to Reduce Falls: Best Practices : Based
on data from 75 hospitals participating in the Pennsylvania Hospital
Engagement Network Falls Reduction and Prevention Collaboration, a
higher percentage of assisted falls and a lower rate of falls with
harm may be associated with the use of sitters. Authority analysts
identify specific sitter program design elements that have the
potential to reduce rates of falls with harm.
-- Improvement of Pennsylvania Healthcare Consumers' Awareness of
Patient Safety : In 2013, 604 randomly selected participants were
surveyed about their respective engagement in 10 consumer patient
safety practices. Results indicate that the patient safety movement in
Pennsylvania is raising awareness of patient safety among healthcare
consumers in the commonwealth. Participants were more inclined toward
asking for an explanation for understanding, questioning unfamiliar
drugs or reasons for procedures, and seeking second opinions about
healthcare, and participants were least inclined toward asking about
-- Commitment to Patient Safety Recognized in Pennsylvania: The
Pennsylvania Patient Safety Authority held its inaugural "I Am Patient
Safety" poster contest during the last few months to highlight
individuals and groups with Pennsylvania's healthcare facilities who
have made a personal commitment to patient safety. This article
highlights those individuals and groups featured on posters this year
in conjunction with National Patient Safety Awareness Week.
-- Wrong-Site Surgery Update : Ten wrong-site procedures were reported
in Pennsylvania operating suites for the quarter of October through
December 2013. Near-miss reports continue to demonstrate both areas of
continued weakness and the effectiveness of the evidence-based best
practices to prevent wrong-site surgery.
For the complete 2014 March Pennsylvania Patient Safety Advisory, go
SOURCE Pennsylvania Patient Safety Authority
/CONTACT: Laurene M. Baker, Patient Safety Authority, (717) 346-1092
/Web Site: http://www.patientsafetyauthority.org
CO: Pennsylvania Patient Safety Authority
IN: MTC HEA
-- DC77592 --
0000 03/06/2014 13:00:00 EDT http://www.prnewswire.com
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