Dreaded H&P Not On The Chart- How Does your organization increase pre-op compliance?

  1. We are monitoring delay in case starts and turnover times. Number 1 cause for us is that the Surgeon has not dictated or written a current History and Physical in the chart. As this is a regulatory requirement that it be present on the chart, our medical staff made the rule that the patients do not go to the OR unless it is physically present on the chart. This causes delays. Does anyone hold the Holy Grail on this? I have heard that some places cancel the case 24 hours pre-op if the H& P is not available when staff assembles the chart. Any tips on improving compliance? What do you do at your organizations?
    Thank you.
    Saint Louis OR Director......................:spin:
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  2. 6 Comments

  3. by   mikethern
    If the H&P is missing, we make the surgeon write an H&P on the spot before the patient enters the room.
  4. by   XJBluto
    Thanks. We do the same, but it causes a delay. I am looking for ways hospitals have addressed this in other ways- proactively that prevent delays. For example, cancelling the surgery if the H&P is not present 24 hours pre-op. If the H&P for tomorrow's cases are not on the chart by 5pm, the case is cancelled after notifying the surgeon by phone that it is not present. If the surgeon then faxes it, etc. , the case continues as planned. Otherwise, the case gets cancelled. Obviously, this will not fix add-ons, urgent cases, etc. We are measuring the reasons for case starts and delays in turnover. In a 1 months tome, the H&P was responsible for 80 of 90 total instances of delays. As you know, when the preceeding cases are delayed, it has a ripple effect throughout the schedule. That, and the fact that my nursing staff spends hours of wasted nursing man hours chasing surgeons around to get the H& P requirement fulfilled.

    What reveolutionary tricks are people doing to get the H&P on the chart proactively???????????

  5. by   ebear
    If the H&P is not on the chart, the surgeon may fill out a "short form" in the pre-op holding area. If he balks at that or refuses just ask him "Sir, how long would you like to wait? The patient will not be taken to the O.R. without a H&P." Granted, these short H&P's are by no means comprehensive, but they do satisfy the requirements. Sometimes they are still in medical records after being dictated. MR can bring or send them up. It may be a good idea to send a letter to the surgeons who practice in your O.R. to emphasize this legal requirement and let them know (once again) the policy and consequences. You can expect the "cry babies" to whine, which is TS. Can you check in to attending a surgical staff meeting with the surgeons to emphasize the importance and show them your data?
    Last edit by ebear on Oct 23, '07
  6. by   maeyken
    If there's no H&P, the patient is not allowed to enter the OR. Fortunately for us this is rarely a problem. Our docs know that if there's no H&P, their cases will be delayed, and if they go late, their last cases could be canceled. Do you cancel cases if they don't finish their cases in their allotted time?
  7. by   traumaRUs
    Hospital where I used to work had a full-time APN who's job was to ensure the H&P was done PRIOR to surgery or she did it.
  8. by   sharann
    Quote from traumaRUs
    Hospital where I used to work had a full-time APN who's job was to ensure the H&P was done PRIOR to surgery or she did it.
    So simple yet not many will do this! I have thought that it takes a full time nurse just to keep track of pre-op stuff. We have this problem with consents as well aas labs not ordered as well. I cannot tell you how many times we see a patient get to pre-op who has eaten a full meal as well because the doctor forget to mention the surgery to the staff nurses or order NPO or a consent or anything.
    Also, don't get me riled about those cardiac clearance deficiencies...

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