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30 Executive Briefing stakeholders together on a daily basis can help en- hance coordination. "I have noticed that one area many hospitals trip up on is the daily huddle — too many organizations fail to involve preadmis- sion testing, scheduling and anesthesia," says Mr. Desai. "Not having an- esthesia at the table can cause a lot of delays with the clearances between pre-op and the OR." Alecia Torrance, MSN, BSN, RN, senior vice president of clinical operations and chief nursing executive for Surgical Directions, agrees that an unin- volved anesthesia department is a major problem. According to Ms. Torrance, when anesthesiologists fail to take responsi- bility for the oversight of the pre-admission testing process and leave it to hospitals without a central command structure, delays are bound to happen. Including a representative from the materials or supply chain department in the daily huddle can ensure all cases the fol- lowing day are adequately prepared. Considering the average hospital OR costs $60 to $80 a minute, according to Mr. Desai, this preparation is key to keeping costs in check. Delays are another major pain point for hospitals. Delays not only cost hospitals financially by compromising reimbursement and revenue, they can prove costly in the area of patient satis- faction, according to Ms. Torrance. "In a way, going to the hospital for an elective procedure is like going to a restaurant after making a reservation," said Ms. Torrance. "If you get to the restaurant and your table isn't ready, you feel undervalued as a customer. Similarly, if a patient arrives at the hospital on the day of surgery and there are major delays, they feel unimportant and brushed aside." Getting clinicians and patients on board with improvement efforts For hospitals that recognize a need to improve their patient optimization practices, it's imperative to engage both the medical staff and patients. Engaging a hospital's medical staff is critical to sustaining compli- ance with standardized patient optimization im- provement efforts. To engage the staff, hos- pitals can establish evi- dence-based protocols, as well as a governance structure or oversight committee. "Clinicians should not only help train and educate hos- pital administrators on patient optimization pro- cesses, they should help lead them throughout the process," said Ms. Torrance. Ms. Torrance suggests creating a surgical services executive committee. This committee should include staff members at the forefront of care: key surgeons, anesthesia personnel and nurs- ing leaders. Hospital administrators should also be involved. Some hospitals hold "town hall" meetings with the surgical staff and other perioperative players to maintain engagement. Standardization is another key, according to Dr. Eappen. "Dif- ferent surgeons and anesthesiologists and perioperative care- givers all have their own way of doing the same procedure, so standardizing optimization protocols is really helpful," he says. "The point is not to handcuff anyone — if there is a good reason for a patient to get tested outside of the standard criteria, that's fine, you should just have to justify it." Although much of the onus to improve pre-operative optimiza- tion falls on the hospital, patients also have a hand in preparing for a surgical procedure. The key is to help patients realize the power they possess, according to Ms. Torrance. "Patients need to be educated on the appropriate times to show up, medications to take and to avoid before surgery, and whether a preadmission testing department even exits," said Ms. Torrance. "They also need to know when they need to meet with the PAT department. It helps when the PAT depart- ment calls patients at home to set up the meeting in a more relaxed environment." Making surgery completely stress-free for patients may seem like a lofty vision, but hospitals can come closer to realizing it by improving their optimization efforts. Doing so will not only put patients' mind at ease, it has the potential to bolster a hos- pital's bottom line. n Sponsored by: Surgical Directions LLC is a national consulting firm based in Chicago that assists hospitals in improving the operational, financial, and market performance of perioperative and anesthesia services. Our consulting team is led by nationally-recognized, practicing anesthesiologists, surgeons, and surgical service professionals experienced in organizational design, block time, surgical scheduling, patient throughput, materials, staffing, strategic planning, and physician relations. Team members have successfully helped over 500 hospitals nationally increase surgical volume, improve clinical outcomes, improve surgeon satisfaction, improve anesthesia satisfaction, and enhance overall perioperative performance. "If a patient arrives at the hospital on the day of a surgery and there are major delays, they feel unimportant and brushed aside."