Lower Cancellation Rates & Increase Efficiencies

 
 

You Can’t Afford to Have a Cancellation.

We have all experienced it at one time or another: waiting on a patient to show, only to have a no show.  Or the patient comes in only to admit they ate breakfast and they all say the same thing, “No one told me I couldn’t eat.” The reasons for same-day cancellations may vary but the consequences are all the same - wasted time, resources, and productivity.  With even 24 hours notice, time can be filled with other cases or consults, even scheduling a meeting or having a well-deserved short day allowing some rest. As an experienced CRNA, I have seen many a patient cancelled on the day of surgery, creating havoc with operating room and office schedules.  Through assessing those situations and digging deeper into the reasons for the cancellations and ways to avoid them, I have been able to work with multiple offices to optimize their scheduling and safely but efficiently work surgeries into your busy office practice.  The bottom line is with a busy practice you simply cannot afford to have a cancellation put a hole in your schedule.

Reasons for cancellations vary, however the big three for ambulatory surgeries are:

  • inappropriate NPO status,

  • no show due to patient being unaware of correct time or place of scheduled surgery

  • patients not having a ride home after receiving anesthesia. 

Other reasons will always come up, but those three are the most common and most easily avoided. 

So What’s the Solution?

The remedy for assuring your practice minimizes same day cancellations is easy, efficient, and takes little extra time.  Two phone calls prior to surgery day has been shown to decrease cancellations. 

Check-In #1: 1-2 weeks prior to surgery day

This is the time to confirm surgery time and place, what to expect after surgery, NPO guidelines, and verifying the patient has a ride home by a responsible party. 

Check-In #2: 2 days prior to surgery day

In the days right before surgery, you need to re-verify that the client has the info you gave in Check-In #1, that they remember it and are prepared. Ensure nothing important was missed by having a call script and checklist so that every patient is given the same correct information.

Checklists used preoperatively have also been shown to increase patient satisfaction. As a final check against error, create and regularly review a call log to make sure every patient has been contacted and given appropriate information.  Within 3 months of implementing a call log and script protocol, cancellations at a surgery center were decreased by roughly 50% - from 16.8% to 8.8% (1).

Although the interventions seem simple, they are not easy.  An in-depth look at your practice, patient demographics, surgery schedule, and reasons for current cancellations need to be done. After this assessment the necessary changes can be made to improve your practice’s optimization on surgery days. 

Rest Easy…We Can Help.

Lanners Anesthesia is uniquely capable of assessing and implementing the changes your practice needs to run more efficiently and decrease same day cancellations. We offer consultative services for efficiency and optimization and can help you find the pre-operative care plan that works best for your practice and your patients. Our CRNAs are also able to take over the entire pre-surgery protocol from you if you would prefer to off-load this task instead of absorb it onto your employees. Contact us today to find out more about how we can help you lower your cancellation rate and streamline the pre-operative process for your practice.

(1) Lee CM, Rodgers C, Oh AK, Muckler VC. Reducing surgery cancellations at a pediatric ambulatory surgery center. AORN J 2017;105:384-391.

Different Types of Oral Surgery Anesthesia

When we work with dental and oral surgery providers, every patient we come into contact with requires anesthesia of one kind or another. Whether it’s a complex procedure such as bone grafting or a more simple wisdom teeth removal, anesthesia brings pain relief and eases nerves during surgery.

Here are a few different ways a patient may be anesthetized during a procedure:

Local Anesthetic

Provided by the dentist or oral surgeon themselves, local anesthetic allows you to remain conscious during the surgery. An anesthetic is injected in and around the surgery area and may be used alongside any other form of anesthesia during a surgery procedure.

Simple, minimally invasive procedures, such as extractions, can be done with local anesthesia alone. Some people even choose to have wisdom teeth removed with only local, though most these days opt to be fully sedated.

Nitrous Oxide Sedation

“Laughing Gas” can be used during simple and more complex procedures. From wisdom teeth removal to implant insertion, nitrous oxide can be a good option.

Before and during surgery, a mix of nitrous oxide and oxygen is inhaled, allowing you to stay conscious yet relaxed. It calms you and helps control pain.

IV Sedation

IV sedation can be provided during all types of oral surgery, and even for your dental cleaning if you have excessive anxiety about coming to the dentist. Most people who undergo complex dental or oral surgery procedures utilize IV sedation to be fully unconscious during their procedure.

Many dentists are certified to do this on their own, without the presence of a CRNA. In order to offer this, your oral surgeon

  • has received additional hospital-based anesthesia training

  • undertaken an in-office assessment by an examiner from the state dental board

  • has passed certification, including having had all monitoring and emergency equipment tested

Many dental and oral surgeons now opt to utilize the skills of a CRNA, such as Lanners Anesthesia, to provide their patients with sedation care throughout the surgery. A CRNA has completed:

  • Master’s Degree

  • 3 years of study

  • 1-2 years minimum of in-hospital anesthesia residency

  • additional ongoing certification

General Anesthesia

General anesthesia can only be provided by a CRNA or anesthesiologist. It is generally offered for those who need extensive work done, such as TMJ surgery or face and jaw reconstruction. It may also be best if you have a medical condition that calls for special attention.

It is our job to ensure patient safety during your procedure. If you have questions or concerns about the type of anesthesia you are going to receive, please reach out to us directly or contact your dentist or oral surgeon.