Story by Maj. Elizabeth M. Bowles, clinical nurse officer in charge, Same Day Surgery, William Beaumont Army Medical Center

WBAMC has stepped up customer service and safety with the implementation of telephonic preoperative nurse instruction for beneficiaries having surgeries and procedures at WBAMC. The implementation of this new process will not only save time, it will also decrease the risk for day of surgery cancellations and increase clinic productivity.

Previously the process typically took 2.5 hours with limited waiting room space leading to overcrowding, particularly when patients brought along family members. Previous processes did not guarantee the completion of required diagnostics available for Anesthesia to review, leading to day of surgery cancellations.

With the implementation of telephonic preoperative instruction, surgical clinics place all orders when the patient is seen and schedule a pre-operation instruction appointment for the patient, who is given a telephonic preoperative packet with a checklist. Patients then proceed to pre-registration with PAD and complete EKGs and diagnostics if needed.

Patients can now complete pre-operative tasks on the same day they are seen at their surgical clinic. Prior to the preoperative teaching appointment, a nurse will review the patient's medical records, results and consult with an anesthesia provider to clear the patient for surgery and/or call the patient for more information, provide medication guidance, or ask for a face-to-face visit. Ninety-five percent of patients are cleared and do not have to return to the hospital before their scheduled surgery.

There are four reasons patients may not participate in telephonic preoperative instruction: cognitive impairment, severe hearing impairment, use of language line required besides Spanish, and for cases involving children under 13 years of age who were born less than 37 weeks gestation. The SDS Clinic is in the process of installing 3 way calling lines which will eliminate the use of the language line as a discriminator for telephonic preoperative instructions.

Ms. Jeanine Knox, telephonic preoperative clinical lead and preoperative registered nurse, worked with each clinic staff member to develop individualized plans which meet the needs of that particular surgical demographic. Knox further developed a patient survey which resulted in a 99 percent satisfaction rate from over 1,300 patients. The process also streamlined, standardized and improved communication between SDS and surgical clinics leading to a more pleasant patient-centered experience.

The new program provides patients more focused attention, safer preoperative screenings, less time waiting and increased preoperative appointments while improving patient care by ensuring higher safety standards are met, patients save time, and work-flow delays are prevented.

The processes developed by WBAMC staff and the committee for this project are currently being shared with the U.S. Army Medical Command as a best practice for standardized, efficient, effective and safe patient care for operative services.