Optimizing Perioperative Processes to Improve Patient Flow and Decrease Cancellations
Authors
- Karla Hamilton, MSN, RN, CNML, Performance & Innovation Consultant, Anesthesiology
- Shawn Stansbery, DO, Facility Medical Director, Anesthesiology
Partnership
- Wood County Hospital, Bowling Green, Ohio
Services
- Anesthesiology
Impact Snapshot
- Day-of lab draws decreased by 80%
- Cancellation rates reduced by 13.4%
- Cancellations within 24 hours reduced by 26.3%
- First Case On-Time Starts (FCOTS) improved by 95%
Pre-admission testing (PAT) is a vital yet complicated process with large impacts on patient flow and surgical cancellations. After identifying a patient flow inefficiency, Wood County Hospital in Bowling Green, Ohio, turned to TeamHealth’s Performance Innovation Consultant (PIC) team to help optimize the preoperative process.
Identifying the Problem
A strong PAT process ensures that patients flow through the surgical process smoother and lowers risk of same-day surgery cancellations, both important measures of success. At Wood County Hospital, the perioperative teams had experienced years of frustration without being able to find common ground or change. Different practice styles and procedures had made it difficult to create clear guidelines that everyone could agree to across departments.
Aiming to try something different, hospital leadership engaged us as their long-time partner to lead the PAT optimization process. The PIC team met with key stakeholders leading up to an on-site event. The main goals were to:
- Review the existing PAT process
- Identify variations in the PAT process
- Identify opportunities to improve
- Provide recommendations based on best practices
- Improve key metrics, such as cancellation rates and delays
Creating Lasting Change
By the time of the on-site event, the various teams were eager to come together to create a cohesive plan. Despite concurrent leadership changes, the team’s energy and collaboration kept the project moving forward. The PIC team reviewed facility data to understand the current state of metrics and to prepare for the event. During the on-site visit, the PIC team had the opportunity to observe the current PAT process and speak with key stakeholders from nursing, surgery, anesthesia, and leadership.
The team identified variations in processes that could be streamlined and standardized. Changes were suggested across scheduling, processes, staffing, charting, and communication. Some of these changes included identifying an “Anesthesiologist of the Day” to review charts and lead communication, standardize scheduling of PAT appointments following surgical requests, and increasing the number of in-person PAT appointments.
Continuing Positive Momentum
Now, the team reports a smoother PAT process – a welcome change from the previous clunky and inconsistent state. More patients can be seen, and more importantly, more patients can be seen safely. The new process improves patient safety by ensuring medically fit patients can receive their surgical care and decreases the number of avoidable cancellations. When the team implemented the best practice recommendations, they saw a decrease in day-of surgery lab draws, which greatly reduces the chance that a case will be cancelled on the day of surgery due to abnormal labs.
Between January 2025 and June 2026, we saw the following results:
- Day-of-surgery lab draws decreased by 80%
- Cancellation rate decreased from 10.28% in January 2025 to 8.9% in June 2026
- Cancellations within 24 hours of surgical procedure decreased from 1.90% in January 2025 to 1.4% in June 2026
- First-case on-time starts (FCOTS) increased from 23.97% in January 2025 to 46.75% in June 2026
Optimizing Perioperative Processes
Optimizing PAT processes can positively impact patient experience and safety, clinician satisfaction, and clinical operations and quality. Wood County Hospital and TeamHealth’s partnership is a testament to the power of collaboration and desire for collective change. Our standardized practices and ongoing support ensure the change can endure and evolve. To learn more about partnering with us, please reach out to our team.
