The 18-month collaboration showed decreased DOS cancellations when a nurse-driven preoperative screening and assessment were implemented

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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

procedures postintervention.

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

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

-0- 03/06/2014

/CONTACT: Laurene M. Baker, Patient Safety Authority, (717) 346-1092

/Web Site:

CO: Pennsylvania Patient Safety Authority

ST: Pennsylvania



-- DC77592 --

0000 03/06/2014 13:00:00 EDT

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