crasies. "We knew it made no sense economically or safety-wise to
have 8 surgeons do things 8 different ways," says Alfred Casale, MD,
the associate chief medical officer and chairman of cardiothoracic
surgery at Geisinger who helped implement the warranty program. "If
there were best practices out there — if there was evidence suggest-
ing the best way to do it and science backed it up — shouldn't every-
one be doing it that way?"
90-day warranty
After 2 years of establishing best practices and other ways to ensure
their patients had safe outcomes, including better patient education,
Geisinger Health rolled out its ProvenCare program in 2006, which
includes for patients a surgical warranty of 90 days where if the patient
experiences any preventable complication, they're taken care of free of
J A n U A R Y 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 2 1
• Include that checklist in your electronic health records.
"That way, the whole system is ensuring that it happens and
you're not relying on someone's memory," says Dr. Casale. "Our
bet was that with 1,000 at-bats, you're more likely to do well with
a systematic approach rather than on diligence and memory."
• Involve the patient. Let your patient and the family help to
improve outcomes by providing them with as much education as
possible. "It's turning the patient and their family into partners
to help get stuff done rather than being lumps on a log," says Dr.
Casale. Give your patients all the information they need both
before and after surgery, including what appointments they'll
need to attend and when to start and stop medication. "We call
that the patient compact," says Dr. Casale. "It's basically an
opportunity to talk to the patients and their families and invite
them to do the right thing for their own care." — Brielle Gregory
