After analyzing the data in a prospective cohort implementation study, researchers in the Department of Anesthesiology Digital Health Lab found that the bundle intervention resulted in a reduced same-day case cancellation rate from 12.3 to 8.4 percent as well as a 35.3-percent increase in cost savings – the equivalent of $150,200 during a 9-month period. The research will be published in an upcoming edition of the high impact factor journal Anaesthesia.

For patients undergoing Otolaryngology ambulatory surgery, the bundle intervention included objective screening tools such as health screening and anxiety screening questions, educational materials to reduce patients’ anxiety prior to surgery, and enhanced digital communication techniques between patients and providers. These digital techniques include enrolling patients in Montefiore MyChart – the patient-facing electronic medical records system – as well as text message (SMS) notifications. The Anesthesiology team also improved preoperative triage, implemented evidence-based clinical guidance for common diseases, and improved interprofessional communication between the surgical, anesthesiology, and scheduling teams.

As part of this multidisciplinary initiative, the Digital Health Research Lab created a never-before used automated tool that helps to determine which patients are at a high risk of case cancellation. This tool was developed as part of a collaborative project with Dr. Jeffrey Freda, Montefiore Health System’s Vice Chair of Perioperative Medicine, Dr. Fran Ganz-Lord, Senior Director of the Montefiore Center for Performance Improvement, and Dr. Richard Smith, Chair of the Department of Otorhinolaryngology, Head & Neck Surgery. One of the main negative effects of same-day case cancellations is that patients’ untreated health conditions that require surgery are prolonged. Further, same-day cancellations reduce utilization of operating rooms, affect surgeon productivity and staff morale, and result in additional costs for patients, physicians, and hospitals.

After identifying which patients are at a high risk of same-day surgery cancellation, our Pre-Anesthesia Testing team works together with Surgical Services to mitigate these cancellations by providing interventions that allow patients to get the treatment they need on time. These interventions include consultations with patients who have a history of anxiety disorder as well as arranging free transportation to and from the hospital for those who have a barrier to accessing transportation. Dr. Carina Himes, Director of Pre-Anesthesia Testing, is leading this endeavor along with three nurse practitioners.

As part of the intervention for patients with a history of anxiety, questions were added to Epic for the Preoperative Evaluation team to assess patients’ anxiety several weeks before surgery.

Based on the questions, the providers now ask patients who have a high anxiety score if they would like a telehealth psychology visit, which is conducted by the Parnes Clinic – a psychology center based at Yeshiva University. According to Dr. Himes, there is a correlation between patients with a history of anxiety and an increased rate of surgery cancellation, which is why the initiative is so important.

“About 60 percent of ORL surgery cancellations within one day of surgery at the Hutch are due to patient no-shows, which is by far the most common reason for cancellation,” Dr. Himes explained. “This is due to patients changing their mind about surgery, and it's hypothesized to be related in part to anxiety regarding surgery."