You have a first surgical case scheduled at 7:30, and you are leaving the parking lot at 6:45 and you receive a phone call from the operating room that your patient didn’t stop their aspirin and the anesthesiologist recommended cancelling the elective surgery. Nothing is more disruptive to a urologist and his/her schedule than to have surgery cancelled on the day of the intended procedure. The last thing a urologist or patient wants is for their surgery to be cancelled at the last moment. It’s stressful and disruptive to everyone involved. In most instances these situations can be resolved before the day of surgery and can be prevented, thus avoiding a costly hole in the urologist’s schedule. This article will discuss the use of a simple check list to prevent cancellations from occurring.

Suggestions when scheduling the case:

1. Contact the patient 7-10 days before the procedure by phone, email, or text as a reminder of date of surgery, hospital, and time to arrive at the hospital/ambulatory treatment center (ATC).
2. Be certain that insurance approval has been received. I recommend that this be in writing as verbal approval may result in doctor, anesthesiologist, and hospital not getting paid and the patient receiving an unexpected bill. Even if the surgical result is excellent, a patient receiving a bill creates an unhappy patient. This is really the responsibility of the practice to be certain that approval and authorization have been obtained before the surgery.
3. If your operation requires a medical device or equipment brought to the operating room, contact the representative and give them the date and the time that the surgery is scheduled and be certain that the representative will be at the facility before the procedure starts.
4. Notify the representative of any special needs you may require for the procedure. An example would be a penile prosthesis, and you believe that you will use narrow cylinders and you want to be certain the representative brings them to the case.

Ten-14 days before the procedure:

5. Make certain that all consultations have been completed and notes from the consultant are on the chart, and copies have been received by the hospital/ATC and reviewed by the anesthesiologist before the procedure. If there is a problem with the facility misplacing or losing the reports and results, then bring a folder with the necessary documents with you to the operating room.
6. Check all the lab work (glucose and potassium) and be certain that anything that is abnormal has been reviewed and approved by the anesthesiologist.
7. Review electrocardiogram and chest x-ray for any abnormalities and requests for additional views, ie, nipple markers.
8. If patients are on aspirin and/or anticoagulation medications, be certain that they have been discontinued 7-10 days before the surgery or that you plan to use a “bridge” approved by the primary care physician, internist, or cardiologist.
9. Preoperative visits with the facility have been scheduled and completed.

One-3 days before the procedure:

10. Make certain the patient has prescriptions filled for postoperative antibiotics and pain medication before the surgery to avoid pain and discomfort after the procedure and no medication available.
11. Nurse or medical assistant contacts the patient and reminds patient to avoid food or fluids after midnight the night prior to surgery.
12. Recommend a laxative or suppository on the day before the procedure so constipation will not be an issue postoperatively.
13. Postoperative visits are scheduled before the surgical procedure.
14. Nurse or medical assistant makes sure all questions by the patient have been answered and, if necessary, have the urologist answer any additional questions the patient may have.
15. And perhaps most important of all, make sure the consent is signed for the practice and the hospital, and that the facility has a copy of the consent on the chart. I suggest that you bring a copy of the consent with you on the day of surgery “just in case” the hospital misplaces the consent you have faxed or sent to the hospital or the ATC.

Afternoon prior to procedure:

16. Medical assistant or nurse calls the patient and reminds about no food or fluids after midnight, and time that the patient is to report to hospital or ATC.

Bottom Line: The last thing anyone, ie, patient and doctor, wants is for their surgery to be cancelled at the last moment. It’s stressful and disruptive to everyone involved and makes for an unhappy doctor and patient. No matter how hard you try to prevent it, some surgeries will be cancelled due to lack of paperwork, insurance refusals, or even human error. The job of the practice is to get those patients back in the system and rescheduled for surgery as soon as possible.