Surgical care team management

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Studies have repeatedly shown that surgical care team management are key to success. Based on my experience running high surgical volumes, I suggest aligning your thoughts into 3 surgery teams.

  1. Preoperative care team – This team that gets the patient to the operating room successfully, fully prepared.
  2. Peri-operative care team – this team ensures surgery procedure success and patient safety
  3. Postoperative care team – this team ensures postoperative patient success

I suggest that you use a surgical scheduling software for it. You can avoid using software if you are very diligent.

Surgical care team software - care team
Surgical care team software – care team

Surgical care team communications

Surgical scheduling workflow involves many team members and many moving parts. It’s best to have everyone on the same page at all times (preoperative, peri-operative, postoperative). Use a spreadsheet or surgery software to ensure effective communication and coordination.

Whether you use email, phone, fax, text messages or HIPAA secure messaging platforms – surgery care team communication is crucial.

If you are using a surgery scheduling software that allows communications, your job becomes a lot easier.

Surgical care team software - communications
Surgical care team software – communications

Preoperative surgical care team

The following is a list of care team members involved in a surgical scheduling process. These folks ensure that the patient has completed all the preoperative requisites, is eligible for surgery, and finally, is prepared for surgery.

If you are using a surgery scheduling software, you can add all these members into a team. Below is a list of surgery scheduling tasks and the associate surgical care team members.

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    Care team for surgery orders

    If you are co-managing surgeries and patient care with another physician, the surgery order might come from the requesting physician office (e.g. optometrists co-managing surgeries with ophthalmologists). 

    In these cases, the following surgical scheduling care team members need to stay in the loop.

    Requesting physician office

    • Appointment scheduler
    • Medical assistant
    • Scribe
    • Physician 

    Of course, your own providers can also identify surgery candidates, place surgery orders. In this case, the following surgery team needs to coordinate with each other.

    Performing Physician / Surgeon office 

    • Appointment scheduler
    • Medical assistant Scribe
    • Physician 
    • Physician office surgery scheduler 
    • Prior authorization staff
    • Denials staff
    • Coder / biller

    Care team for laboratory orders

    This would include prior authorizations, patient preparation, laboratory results.

    In almost all cases, your surgeon will place various preoperative laboratory test orders. A surgical scheduler’s job is to send the referral to the laboratory. They do not have much visibility into the referral order until after the test results are obtained from the laboratory or the patient themselves.

    I recommend handling the pre-requisites of the laboratory order appointment yourself. This way, you have full control of your surgical timelines.

    Following are the patient care team members that need to get involved for expedient preoperative laboratory order results.

    Laboratory

    • Appointment scheduler
    • Lab technician Physician
    • Prior authorization staff
    • Denials staff
    • Coder / biller

    Care team for imaging / diagnostic orders

    This includes prior authorizations, patient preparation, laboratory results tasks.

    Your surgeon will place various preoperative diagnostic/imaging procedure / test orders. The referral needs to be sent to the diagnostic facility. 

    Here as well, I recommend handling the pre-requisites of the order appointment yourself. 

    Following are the patient care team members that need to get involved for expedient preoperative imaging order results.

    Imaging / diagnostics center

    • Appointment scheduler 
    • Technician 
    • Physician 
    • Prior authorization staff
    • Denials staff
    • Coder / biller

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      Care team for medication orders

      You have tasks related to prior authorizations, patient preparation, medication adherence.

      The surgeon will certainly be placing several preoperative, peri-operative and postoperative medication orders. While surgical scheduling staff doesn’t always have to handle the postoperative medication orders – they do have to ensure preoperative and peri-operative medication orders are placed, dispensed and administered as ordered.

      Following are the patient care team members that need to get involved for expedient preoperative medication orders.

      Pharmacy 

      • Pharmacy Technician 
      • Pharmacist 
      • Prior authorization staff
      • Denials staff
      • Coder / biller

      Care team for medical clearance

      Each surgery is going to have medical clearance referral requirements. This requires you to send a referral to the primary care physician’s office for a complete history and physical.

      Try to get the complete medication list from the PCP as well. This helps with the medication history list that needs to be sent along with the surgery packet (to the surgery facility).

      For the history and physical to be done expediently, the following staff from the PCP office need to work together and communicate well with your office.

      Primary care physician office

      • Appointment scheduler 
      • Medical assistant 
      • Physician 
      • Prior authorization staff
      • Denials staff
      • Coder / biller

      Care team for specialty clearance

      Based on the patient’s medication conditions (existing) and possibly, the co-morbidities, your surgery scheduling might need to include specialist medical clearance(s). This requires you to send a referral to the specialist physician’s office for a clearance (e.g cardiology, pulmonary, hematology etc.).

      Try to get the complete specialty medication list from the specialist office as well. This helps with the medication history list that needs to be sent along with the surgery packet (to the surgery facility).

      The following staff from the specialist office need to work together and communicate well with your office.

      Specialist office

      • Appointment scheduler 
      • Medical assistant 
      • Physician 
      • Prior authorization staff
      • Denials staff
      • Coder / biller

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        Care team for operating room supplies, block times

        Surgeon preference cards typically cover most of the operating room supplies requested by each surgeon. Whether your surgeon is part of the surgery facility / hospital itself, or if they have hospital privileges, you need to keep the surgeon preference cards up to date.

        Typically a surgeon preference card would note the following:

        • Supplies and custom packs (if any)
        • Instruments and Trays
        • Equipment
        • Gloves
        • Sutures
        • Medications
        • Implantable items

        Your surgeon will often ask the implant vendor sales representative to be present in the operating room.

        You will also need to work with the OR surgery scheduling team to ensure you get the correct block times, optimize your surgeon’s schedule and move the each surgery scheduling plan along.

        This is where a lot of the communication gaps occur (preoperative/surgery scheduling). Typically, the following surgical care team members have to coordinate and communicate well.

        Surgery center 

        • Surgery scheduler 
        • Logistics/ supplies manager 
        • Anesthesiologist Nurse
        • Prior authorization staff
        • Denials staff
        • Coder / biller

        Implants vendor

        • Logistics / order manager 
        • Implant / device representative 

        Care team for escorting patient to / from surgery center

        Many times, your patient will be escorted to the surgery facility by a related person. Or, the patient might come in themselves. However, patients are not allowed to leave the surgery facility without an escort. If the patient is leaving with a related person, the patient escort also becomes part of the care team.

        Patient escort (related persons)

        If the patient needs transportation arrangements to arrive at the surgical facility, then you would need to arrange and manage transportation for the patient. In this case, the transportation vendor staff also becomes part of the patient care team.

        Transportation vendor

        • Appointment scheduler 
        • Driver

        As the patient leaves the surgery facility, they cannot be released to a general transportation vendor that will not accompany the patient for a few hours postoperatively. In these cases, you would need to help the patient arrange for an escort from services like those offered by Visiting nurse services. 

        In this case, you need to coordinate with the vendor’s patient escort team.

        If you are using our surgery scheduling software, we handle these tasks as shown below

        Patient escort vendor

        • Appointment scheduler
        • Attendant
        surgery scheduling software transportation order
        surgery scheduling software transportation order

        Care team for Prior authorizations

        You need prior authorizations for almost all your procedure, medications, transportation, devices orders.

        While the payer’s staff never really becomes part of the care team per se, you do need to coordinate with them for almost everything (if the patient is not a self pay patient). Unless you have expedient responses from the insurance / payer office w.r.t various prior authorization requests, your surgery scheduling will surely lead to delays. 

        Insurance / payer office

        • Customer service representative
        • Adjudicator

        If you are using our surgery scheduling software, we handle these tasks as shown below

        Surgical care team software - authorizations
        Surgical care team software – authorizations

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          Surgical care team

          The surgical care team that’s actually performing the procedure includes the following team members:

          1. Surgeon
          2. Anesthesiologist
          3. Certified registered nurse anesthetist (CRNA)
          4. Operating room nurse
          5. Surgical technician(s)
          6. Residents or medical students (depends on whether it is a teaching hospital or not)
          7. Physician assistant
          8. Medical device company representative (as mentioned above, often, surgeons would request the device representatives to be present during the procedure).