You won't believe all the extra time you'll have on your hands when you let patients register for their surgeries online. Those countless hours your staff spends making pre-op phone calls, compiling medical histories and pushing piles of paper? You can reclaim them and put them to better use. Since we armed our 2 busy orthopedic surgery centers with pre-op screening software about a year ago, we've saved more than $40,000 in nurse staffing hours and shaved 1.5 FTEs off the nursing payroll. And our patients are more satisfied than ever with our ultra-efficient pre-admission process. Read on to find out if online registration is right for you.

Surgery's great little shortcut
Patients are busy at work or shuttling kids around town, so trying to get them on the phone for extended conversations about their health histories is often difficult. Online admission software stops the endless games of phone tag. Here's how it works.

As soon as you add a case, physician schedulers hand patients hard-copy directions — or send electronic versions via e-mail — on how to submit pre-admission forms online. Patients then access the forms through links on facility websites or in e-mail messages and complete medical histories specifically designed for the procedures they're scheduled to undergo.

Patients can complete the forms when it's best for them — after the kids have been put to bed, during a lunch break at work — instead of when it's convenient for you. They can also start registering, save their progress, deal with distractions and return to the task when time permits. But most patients say they can complete the process in about 15 minutes. Forms must be fully filled in before the software accepts them, meaning you receive completed forms ready for review.

Our area — the northern Virginia suburbs of Washington, D.C. — is populated with computer-savvy individuals, so most of our patients prefer to communicate online. Within the first month of implementing our pre-admission software, between 85% and 90% of our patients used it to register. Since then, online registration has been close to 100% compliance.

Patients who aren't computer literate are welcome to call one of our pre-op nurses for step-by-step directions on accessing the online registration forms. Once patients are shown the way, most can complete the process without difficulty. Our pre-op nurses will, however, create online medical profiles for technology-challenged patients who either have trouble navigating the system or don't have access to a computer.

A stitch in time
Online registration software provides patients with information about the procedures they're about to undergo and what to bring on the day of surgery such as lists of medications they're currently taking. (Patients check a box after reading the educational material, so you know they've read the instructions.)

You can set up the system to designate medications, medical conditions or demographics to trigger alerts — for example, patients 55 years and older must have an EKG, regardless of their health status, before undergoing surgery at our centers. Pre-op nurses can then pull "red-flag reports" and address issues or schedule needed tests well before patients arrive at your facility, instead of waiting until pre-op phone calls made just days before surgery, when it might be too late to avoid canceling cases. The system can also flag borderline concerns that might simply require an anesthesia review before cases can proceed. Finally, nurses can quickly identify patients who aren't suitable candidates for surgery in your center, direct them to the local hospital and slide another case into the schedule without delay.

Information from patients' online health histories pre-populates their charts, which dramatically reduces the amount of administrative time nurses spend getting documents ready for the next day's cases. Keep in mind that any overtime hours nurses currently clock hand-writing information into patients' charts disappear from your payroll expenses. You pay nurses to spend more time being nurses.

Pre-op nurses still call all scheduled patients in the days leading up to surgery, but most of the conversations last less than 10 minutes — nurses simply verify they've received the online forms, confirm they've been completed and quickly review information noted in patients' health histories — instead of the hour or so it takes to complete pre-op documentation manually. Nurses who spend fewer hours on the phone are able to spend more time supporting staff throughout the center, which ultimately lets the other nurses who used to shore up shorthanded areas focus on the tasks to which they were originally assigned. Staffing hours are saved in that respect, too.

Patients own their online health histories after they've created them and have unlimited access to the information, meaning they can update their records and print out forms to take wherever they go for care. We were one of the very first surgery centers in our area to use the technology, but several centers have followed suit. Patients can now send their health histories to several other local facilities with just a few clicks of the mouse, and don't have to fill out the same forms over and over again. In addition, our Spanish-speaking patients can convert the online documents to their native language. When the completed forms are submitted to our centers, the system converts the information back to English.

We added a question to patient satisfaction surveys that specifically asks about the online pre-admission registration process. All responses have been "very good" or "excellent" since the system's launch.

ON THE FLY Text messaging can save surgeons several minutes between cases.

CONSTANT COMMUNICATION

Text Updates to Patients' Families & Friends

Send text messages to patient escorts as soon as surgery concludes to relieve their anxieties and ensure they're available in the waiting room to meet with surgeons, says Rahul Shah, MD, medical director of perioperative surgeries at Children's National Medical Center in Washington, D.C.

At Children's, surgeons log into a text messaging service (www.mycaretext.com) from a computer in the OR and, with a few clicks of the mouse, send canned updates — "Surgery complete, everything went well," for example — to as many as 5 members of patients' care circles, whether they're escorts waiting in the facility to drive patients home or relatives and friends waiting anxiously elsewhere. (Contact phone numbers are added to the messaging system when patients register for surgery.)

Physicians who use the service don't have to alert someone else to contact friends or family or wait around for those who are unaware their loved ones are out of surgery, says Dr. Shah. "That saves about 5 minutes at the end of each case, which may not sound like much, but the minutes add up."

The texting service also does away with the restaurant-style pagers — which cost a couple hundred dollars each and are easily lost — used by some facilities to alert patient escorts that cases have concluded. Escorts instead receive notifications on their mobile communication devices, which, let's face it, is the preferred method of staying informed for a growing number of tech-savvy individuals.

— Daniel Cook

PAPER WAIT Commonwealth Orthopaedics pre-op nurse Carol Calvert, RN (left), and Nurse Manager Lisa Shirkey, RN, spend less time filling out forms.

Affordable upgrade
Find a software vendor that will go above and beyond to get the program up and running and who's easily accessible to help you troubleshoot issues whenever they arise. Our vendor spent a great deal of time with nurses, physicians and anesthesia providers to better understand their needs, and reviewed our chart paperwork and current histories, so the online versions matched both.

We paid a one-time setup fee, which was minimal considering the number of hours we worked with the vendor to create a system customized to our facility. We now pay a nominal per-click charge for records created by patients who ultimately end up in our center, which is essentially less than a tenth of what we'd pay a full-time nurse to handle the pre-administration duties. The software has been an affordable upgrade that in no small way improved our day-to-day operation. We've never looked back to the old way of doing things. Phone calls and paperwork? No thanks.