Schedule Changes

Managing the ASC schedule when The Unexpected Happens

Cancellations, misbookings, urgent add-on surgeries all take a toll on a well-planned schedule. Here’s how to restore order and get back on course.

Pamela Major, CASC, Boston, MA

It couldn’t have happened on a light day, perhaps when only 2 or 3 surgeons were scheduled. No, it’s Wednesday, 6 surgeons, 55+ cases, the schedule is finely tuned and tight. Well, it was anyway…

At 6:00 a.m. the phone rings. “Dr. Smith has food poisoning and won’t be in for his 7:00 start. Please cancel his 10 patients for the day, (most of whom are already sitting in the waiting room), and find another day within the week to move them.”

With one phone call, the finely-tuned scheduled is shattered. Now it’s pick up the pieces, rearrange them and restore order. Such a feat requires a professional who is flexible and prepared for myriad contingencies. The scheduler must at once be able to handle cancellations, incorrectly booked cases and emergency surgeries—all changes that impact patients, staff and doctors alike. One false move could lead to a domino effect.

Other cancellations

Each unexpected cancellation, as illustrated in the following scenarios, brings its own challenges:

■ An accident causes traffic to stop dead. None of the patients or surgeons are able to get to the surgery center until it is cleared, pushing back all the cases for the rest of the day.

■ A state of emergency has been declared due to an overnight blizzard. Surgery cannot be rescheduled until the roads are clear, utilities restored, etc.

Incorrectly booked case

Sometimes a surgical case is booked without all the necessary information. For example, on the day of surgery the surgeon arrives and says all the cataract cases were supposed to have been femtosecond laser cataract procedures with Optiwave Refractive Analyzer, which increases each case time twofold. The result: O.R.s must be switched, the following surgeon’s start time is delayed, and patients wait longer than expected.

Other issues can interfere with bookings, such as:

■ An incomplete surgical packet or site discrepancy on day of surgery. This results in a delayed start or possible cancellation of the case if patient paperwork or confirmation cannot be obtained in a timely manner.

■ Preferred order of cases or special needs that were not communicated, such as the need for an interpreter, special instruments required for the case, or special order lenses.

The same day add-on

Or, imagine an urgent retina procedure needs to be done same-day, requiring the staff to find room in the schedule or adding the case to the end of the day. Is staff able to stay late? Can the anesthesia team stay late? Will all the paperwork arrive from the practice complete and in time? How will the case effect the start time or flow of other surgeons?

Communication: divide and conquer

The scenarios are many and we all have experienced times when the unexpected happened. Unfortunately, any change to the surgery schedule has a cumulative effect on all involved. The patients, the staff (both at the ASC and the practice), the anesthesia team, and the surgeon. It’s all hands on deck when the schedule needs to be shifted.

When schedule changes occur, the first step of the ASC administrator is to “divide and conquer.” Immediately assign specific staff members to inform the surgeon, the patients and the staff with information regarding the delay or cancelation or addition of cases. The assigned staff must communicate as soon as possible, as to prevent travel inconvenience or unnecessary wait time or O.R. lag time.

A great front desk person is an asset who can calm anxious patients and family members, regardless of whether they are in the waiting room or on the phone.

Creating a solution

Once all parties are informed, the ophthalmologist’s practice and the ASC should work as a team to find the best solution, as many variables will play into the rescheduling of cases. Surgeon and anesthesia availability, O.R. availability, staff flexibility and patient availability all need to be coordinated.

When rescheduling, consider these questions: Could the cancelled cases still be completed on the same day by extending hours, opening another O.R. or adding staff? If not, how soon can the cases be accommodated? Could the cases be split over time onto different days? This can be easier than finding a whole block that is open and expedite the completion of the cases in a timely manner.

Also, consider these tips for rescheduling:

■ Fill the holes. The most common schedule disruption and perhaps the easiest to remedy is the last minute patient cancellation that creates a hole. This can be filled by the surgery center staff by making calls to move patient times up in the schedule or to find out if the next surgeon can begin sooner. A quick schedule review at the end of the day prior to surgery can also catch holes from cancellations.

■ Close the loop with communication. Make the office practices and billing groups aware of cancellations the day of surgery. Stay in touch with a point person at the office practice regarding rescheduled days and if any patient paperwork (i.e., history and physical), needs to be updated for the new date.

Assessment

After the day is done, the cancellations, additions, and modifications have been taken care of; it’s take time to come up with a plan of action for future cancellations. The input of the staff helps with the overall success of each surgery day.

■ Emphasize what is important. Patient care, communication, and team work are the priorities.

■ Minimize the preventable cancellation. Communicate the importance of complete, timely, and accurate transfer of information between the surgeon’s practice, the patient and the ASC.

■ Manage the unexpected. Be solution oriented, utilize available resources, and communicate expectations in a positive and productive manner.

And when they happen, enjoy those days when everything flows perfectly, on time, and the patients and staff leave with a smile. OP