Travel First Class With PAT

Methodist Hospital (San Antonio, Texas)

CSI Summary

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CSI Presentation

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Project Topic:

Increasing the use of pre-admission testing (PAT) to decrease surgical cancellations

Hospital Unit:


CSI Participants:

  • Claire Adian, MS, BSN, RN, CPAN
  • Latina Gonzalez, BSN, RN, CNOR
  • Marivel Klar, ADN, RN
  • Natalie Martinez, MSN, RN, CNL
  • Karen Zaiontz, MSN, RN

Project Goals/Objectives:

  1. Increase the use of PAT among patients undergoing elective orthopedic surgery from 60% to 70%
  2. Decrease overall cancellation rate 3%
  3. Improve patient education and outcomes among patients undergoing elective surgeries with orthopedic block schedule surgeons

Project Outcomes:

  1. Increased PAT 10%, generating an additional $345,600 in estimated yearly revenue
  2. Reduced cancellation rate 1%, generating an additional $254,096 in estimated yearly revenue
  3. Garnered interest from other service lines for participation in PAT
  4. These outcomes resulted in an estimated annual fiscal impact of $599,696.

Project Overview:

The cancellation rate for knee replacement patients at our hospital was 6.6%, meaning that the hospital was missing opportunities for income related to the canceled cases. Evidence showed that patients who participated in pre-admission testing (PAT) before surgery were 4.5 times less likely to be canceled prior to surgery than to patients who did not participate.

Our CSI project focused on increasing the use of PAT to allow the hospital to bill for services rendered from PAT as well as from the surgery itself. Our strategy centered on introducing a new process that emphasized patient education. We developed learning materials for staff to share with patients, created a logo and swag, hosted a kickoff event, provided staff education and even held a competition

As our project progressed, we gained interest from service lines outside of orthopedics because our results showed that patients were less likely to be canceled, giving physicians the opportunity to optimize their patients prior to surgery.

We successfully decreased overall cancelation rates by 1%, leading to a significant increase in revenue to the hospital of $599,696 annually. (Note: this figure applies solely to elective knee replacement patients.)

The feedback about our project's interventions has been positive, especially since we have been able to gain interest from other service lines with high surgical volumes. This outcome allows for a positive sustainability plan by preemptively creating buy-in from other key service lines that could create an increase in their annual revenue.

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The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.