How does your hospital schedule surgeries?

[grouchy]

I work on a stepdown unit where we send people for cardiac caths, angioplasties, stents, and pacemaker/AICD placements. This place is so screwed up that we do not know what times any of our patients are going to surgery, we can't get that info, this has always caused huge amounts of pt/family tension, but mgmt is unconcerned. I recently told my boss about how Sears gave me a 4-hour time window for my appliance delivery, called to confirm/ called again to warn me they were running late due to the weather(and offered to reschedule if I wanted), called to see if I was satisfied, etc., and if they can do that, we should be able to do something similar. Her response: not posssible, because of the occasional emergency surgeries. (The real problem has less to do with emergency surgeries and more to do with surgeons running back and forth between us and a nearby hospital, and losing scheduled surgical slots to whomever is available in the building when an OR opens up because they are over at the other hospital - thus, the schedule gets rejuggled all day long. Surgeries run over, causing some backup, but getting bumped for emergencies is relatively rare.) I felt like telling her that now that we have multiple new competing cath labs in the areas, that answer is not good enough. You better figure it out, because if you don't, someone else will. I think our pts would be much happier if they had at least some vague idea of when they were going - like morning or afternoon, and would accept that we can't give an exact time, and that there is a slight risk of getting bumped. Families just want to have an idea of whether they should take a full or partial day off from work, when to expect discharge, etc.

So, I'm asking you guys how this problem is handled at other hospitals. Doesn't have to be cardiac - just any area where they juggle scheduled and emergency procedures, like inductions/C-sections, for example. A couple of months ago, I had a guy, nothing to eat or drink since midnight, waited all day to go down for a pacemaker, not knowing what time he would go, finally went to the OR at 5 PM, then got bumped (in this case, for a true emergency) while in the holding area, and sent back to the floor, to have the surgery the next day. You can imagine what a happy camper he was. There's gotta be a better way - please tell me what that better way is.

[CIRQL8]

Routinely surgeries are scheduled VIA the surgeon's office VIA Fax or phone call. Surgeon (most) have block time. If block time is not used, or only partially used, it is released 7 calendar days before the actual day. Cases schedules are not cancelled, but the remainder of the block time is available for anyone else. There are also blocks of unassigned times, available to anyone, and certain groups or services with lower census share block time.

We share level I trauma with a neighboring hospital (chnage off every other year), so emergencies happen regularly. We have two rooms held for trauma during our trauma year, and one reserved for emergencies for our off-trauma year. If staffing concerns need to bump a surgery, it is the 'bumpers' responsibility to contact the 'bumpee' and the surgeon who is bumped will contact the family and let them know of the delay. If a surgeon is late, we will inform the pre-an holding area, who in turn will inform the patient/family.

Except for first starts, I don't know of any surgeon who routinely is not a little late for to follow procedures.

We don't really call patients at home to delay their arrival. The surgeons will cancel themselves if need be - and if the patient is nothere yet we will provide a courtesy and call the patient at home for the surgeon (if they so request).

What kind of scheduling software do you use? Most these days will estimate the length of time for a procedure and promt the scheduler not to follow another case too closely.

It's not always a good idea to keep patients away from the facility until last minute... As much as cases get delayed, they also move up for many reasons. If case two is cancelled, case three can go sooner, etc! We have patients show up 2 hours before scheduled (or estimated) start time. It takes time to check in and get pre-op'd.

P.S. - I work in General Surgery (not CVOR or cath lab). Other things and places, I'm sure, can be quite different.