necessitating a call to the anesthesiologist or surgeon to fill in the
blanks.
Then we stepped back to the anesthesiologist's review at noon on
the day before surgery. Even more of the charts were missing tests
and histories. Have you ever witnessed the distress of an anesthesiol-
ogist assessing an incomplete chart for patient safety? Suffice it to
say, he'll affix a red dot to the chart and send it back to the pre-admis-
sion testing (PAT) nurse and secretary who assembled it, with orders
to track down the details ASAP.
Root causes
It's not the PAT department's fault, and it's no wonder they often feel
frustrated and unable to catch up. They're surrounded by charts cov-
ered with dots and notes. When pre-procedure orders arrive 96 hours
before surgery, up to 60% are missing test results. The results and
patient interviews come in randomly, at different times — sometimes
as late as the night before surgery — requiring them to repeatedly
locate and update charts.
We discovered a huge obstacle here. The PAT nurse's main sources
of information in assembling the charts were the surgeons' pre-proce-
dure testing orders. But each surgeon's office manager used different
forms and filled them out differently, illegibly, incompletely or not at
all. This required additional e-mails and calls to clarify the orders.
Adding to the inefficiency, the surgeons' offices usually waited for
PAT to let them know that test information was missing, instead of
sending it over when they had it in hand. So more time and effort was
wasted as the nurse and secretary contacted the office, and some-
times testing locations, multiple times, day after day, to round up the
information needed for every chart.
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