Development of an NP-Managed Preoperative Orthopedic Clinic
Development of an NP-Managed Preoperative Orthopedic Clinic
A nurse practitioner–managed preoperative evaluation clinic was developed within a large orthopedic practice. For 3 months, a nurse practitioner provided comprehensive preoperative medical care. Surgical cancellations and lost revenue were compared with the previous year. Data analysis revealed that cancellations attributed to the clinic were lower when compared with primary care providers, 0.8% (n = 112) versus 7.7% (n = 450), respectively. Lost revenue from 36 surgical cancellations during the study was $184,480, whereas lost revenue in the previous year from 77 surgical cancellations was $386,033. The relationship between the preoperative care provider and surgical cancellation rates was statistically significant, χ (1, N = 571) = 7.15, P = 0.007.
Each year, more than 51.4 million inpatient and 34.7 million outpatient surgical procedures are performed throughout the United States. Recognizing the risk of all surgical procedures, clinical practice guidelines recommend that all surgical candidates undergo a preoperative evaluation before any surgical intervention. The purpose of a preoperative evaluation is to verify and optimize patients' medical conditions while identifying and minimizing any actual or potential pre-, intra-, or postoperative complications. Evidence-based standards of care from the American College of Cardiology, the American Society of Anesthesiologists, and the American Academy of Family Physicians, among others, provide specific recommendations based on the surgical intervention and patient comorbidities. As such, health care providers should customize preoperative evaluations for each patient, including any corresponding diagnostic testing.
There is a lack of standardization and collaboration among surgeons, patients, and primary care providers, resulting in uncoordinated and costly preoperative care. The uncoordinated and burdensome preoperative evaluation process often leads to unnecessary surgical delays, cancellations, and increased health care spending. To address this growing concern, many health care organizations have developed preoperative evaluation clinics (PECs), wherein patients can receive timely preoperative evaluations and ancillary testing in one convenient location.
Although PECs have been in existence for over 20 years, current health care trends have led to their widespread utilization. PECs have been shown to reduce the number of surgical delays and cancellations as well as shorten the time between surgical evaluation and subsequent surgical intervention. In addition, PECs improve care coordination, patient satisfaction, and the overall quality of preoperative care. A recent trend among PECs is to utilize nurse practitioners (NPs) to coordinate preoperative care. NPs have a rich 50-year history of providing cost-effective, high-quality patient care, and are ideally suited to provide comprehensive preoperative care within a PEC.
Abstract and Introduction
Abstract
A nurse practitioner–managed preoperative evaluation clinic was developed within a large orthopedic practice. For 3 months, a nurse practitioner provided comprehensive preoperative medical care. Surgical cancellations and lost revenue were compared with the previous year. Data analysis revealed that cancellations attributed to the clinic were lower when compared with primary care providers, 0.8% (n = 112) versus 7.7% (n = 450), respectively. Lost revenue from 36 surgical cancellations during the study was $184,480, whereas lost revenue in the previous year from 77 surgical cancellations was $386,033. The relationship between the preoperative care provider and surgical cancellation rates was statistically significant, χ (1, N = 571) = 7.15, P = 0.007.
Introduction
Each year, more than 51.4 million inpatient and 34.7 million outpatient surgical procedures are performed throughout the United States. Recognizing the risk of all surgical procedures, clinical practice guidelines recommend that all surgical candidates undergo a preoperative evaluation before any surgical intervention. The purpose of a preoperative evaluation is to verify and optimize patients' medical conditions while identifying and minimizing any actual or potential pre-, intra-, or postoperative complications. Evidence-based standards of care from the American College of Cardiology, the American Society of Anesthesiologists, and the American Academy of Family Physicians, among others, provide specific recommendations based on the surgical intervention and patient comorbidities. As such, health care providers should customize preoperative evaluations for each patient, including any corresponding diagnostic testing.
There is a lack of standardization and collaboration among surgeons, patients, and primary care providers, resulting in uncoordinated and costly preoperative care. The uncoordinated and burdensome preoperative evaluation process often leads to unnecessary surgical delays, cancellations, and increased health care spending. To address this growing concern, many health care organizations have developed preoperative evaluation clinics (PECs), wherein patients can receive timely preoperative evaluations and ancillary testing in one convenient location.
Although PECs have been in existence for over 20 years, current health care trends have led to their widespread utilization. PECs have been shown to reduce the number of surgical delays and cancellations as well as shorten the time between surgical evaluation and subsequent surgical intervention. In addition, PECs improve care coordination, patient satisfaction, and the overall quality of preoperative care. A recent trend among PECs is to utilize nurse practitioners (NPs) to coordinate preoperative care. NPs have a rich 50-year history of providing cost-effective, high-quality patient care, and are ideally suited to provide comprehensive preoperative care within a PEC.
