It appeared to be as simple as reaching out and touching someone.
For the staff of El Camino Surgery Center in Mountain View, Calif., an innovative way of dealing with patient cancellations became more than just a phone call that preceded a surgical procedure.
"The most important benefit of this project is that, in the chaotic industry of healthcare today, the El Camino staff has learned skills that would benefit any organization," said Pam Aggerbeck, an operating room nurse who headed El Camino's risk management team.
When a patient is scheduled for ambulatory surgery at El Camino, it becomes a risk management issue. The freestanding surgery center, which opened in September 1991, is owned by El Camino Hospital and a group of investors. It includes six operating rooms and two procedure rooms, averages some 6,000 cases per year and generates more than $11 million in annual revenues.
The center's staff has found cancellations cause delays in other surgeries, conflicts with equipment use and inconveniences for staff.
"Sometimes you open up the surgical packs just before a surgery and find the patient canceled at the last minute," Ms. Aggerbeck said.
From $2,000 for an hour of operating room time to $30 to $50 worth of surgical procedure packs, the risk management staff figured 44 minutes of unused resources cost an average of $2,058 per cancellation.
The answer wasn't to reduce staff.
"Our concern is that healthcare organizations frequently cut costs by eliminating nursing staff," said Nancy Webb, executive director of El Camino. "These are the very people who can most successfully provide the care which gives patients a positive experience and outcome while proactively managing expenses."
Recognition of the problem began shortly after the surgery center opened in August 1991. Nurses realized some patients were making their way through admitting and pre-operative services, and to the operating room, before they were ready.
Some of the patients getting through to the operating room were considered "unsuitable." For example, an unsuitable patient may have a lung condition and present a potential respiratory arrest problem.
And, because cataract extraction accounts for 23% of the center's business, many elderly people use El Camino, which adds to the number of cancellations.
The risk management team began brainstorming at weekly two-hour staff meetings. It was during the discussions on improving general operations that team members realized canceled appointments were costing the center plenty of time, money and energy.
A study of the problem showed the surgery center was averaging 3.25 cancellations a month and had 15 in September 1993, the month before the risk management team implemented its program.
"We found a (verification) call the day before surgery wasn't good enough," Ms. Aggerbeck said. "Sometimes they weren't at home, or they were at the doctor's office getting a last-minute exam before surgery."
The team recommended a pre-operative secretary be hired to organize and maintain charts, answer the telephones and coordinate the completion of the pre-operative calls, freeing nurses for patient care.
The management practice used at the center provides a lot of autonomy and a high degree of accountability to the people doing the work.
The program has been an unqualified success. "Since the team began its pilot study and staff education, there have been no cancellations of surgery due to suitability issues," Ms. Aggerbeck said. "We've had cost-effective use of resources and avoided loss of revenue. As much as everyone wants to increase patient load, we don't want to (increase) a patient's risk."