P023: ANESTHESIA-LED CURRICULUM FOR PREOPERATIVE MEDICAL OPTIMIZATION
Ryan P McCafferty, DO1, Brendan J McCafferty, MSII2, Norvan K Vartevan, DO1; 1Larkin Community Hospital, 2University of Pikeville Kentucky College of Osteopathic Medicine
A systematic approach to preparing patients for elective surgery will help minimize the number of cancellations and the subsequent consequences. Cancellation of elective surgeries is costing hospitals hundreds of thousands of dollars every year. From January 1, 2014 to July 31, 2015 at Larkin Hospital, 14% of scheduled surgeries were cancelled. In contrast, in 2009, researchers from Tulane University Medical Center concluded that 6.7% of scheduled surgeries were cancelled, costing the hospital nearly $1 million that year alone. General surgery cancellations alone cost the hospital over $200,000 and was the specialty with the highest loss of revenue. A few examples of why an anesthesiologist decides to cancel or delay a procedure that are considered avoidable include NPO violations, acute illness, failure to stop anticoagulant medications, electrolyte imbalances, respiratory problems, significant cardiovascular history, acute arrhythmias and lack of patient proxy or consent. Same-day cancellations should never occur for reasons that could have been detected earlier. The anesthesiologists, surgeons, and primary care physicians need to have a system in place to improve communication and minimize the cancellation rates. The goal of this study is to improve the education of the primary care physicians and the quality of the system used to evaluate patients preoperatively and on the same day of the operation. This advanced system will decrease cancellation rates and result in a decreased total loss of revenue. We began the education process by administering a pre-exam that consisted of 20 questions to each resident in the different medical and surgical specialties one week prior to the education presentation. We then presented a one-hour lecture to each specialty with information pertaining to cardiovascular guidelines, electrolytes, NPO status, anticoagulant medications, blood products, and classifications of surgery. After completion of the presentation we administered the same exam that was given as a pre-test one week earlier. We then graded each test to determine if the lecture improved the resident’s understanding of preoperative evaluation. The data collected following the examination and lecture included an overall average pre-exam score of 57.5% and a post-exam score of 86.6%. The highest pre-exam score belonged to Anesthesia with an overall average of 75% and the largest increase in average belonged to the surgery specialties who improved from an average of 50% to 90%. These results have led us to believe that there is a need for continued education on the proper way to optimize a patient prior to scheduling a surgery. With this knowledge we will continue to present this material each year to the different medical and surgical specialties as well as participate in grand round lectures to improve the care and safety of our patients. To follow up on the effectiveness of this lecture in decreasing the number of cancellations we will continue to track the cancellations at Larkin Hospital along with the reasons for cancellation to determine if the presentation is effective and should be adopted to a wider audience of providers.