Reducing Last-Minute Cancellations Through Optimized Endoscopy Ordering and Scheduling

Picture yourself as a patient who decides to become proactive with your health after a heart attack. You learn about the importance of colorectal cancer screening, call to schedule a colonoscopy and complete all of the prep. Then you arrive at your appointment, only to have the clinical team determine that due to your medical history, you need to reschedule the procedure at a hospital location.

The GI Optimization project sought to prevent these unnecessary cancellations by implementing standard technology workflows. Leveraging electronic health record (EHR) software, clinical best practices guide ordering and scheduling to ensure patients receive the same safe, high-quality care across the health system.

Standardized clinical guidelines

A multi-disciplinary group of providers and clinicians from the Anesthesiology Institute, Cleveland Clinic Community Care and the Digestive Disease & Surgery Institute collaborated to develop a risk stratification process, creating a matrix of clinical criteria that drives patient scheduling. A patient’s medical history and diagnoses determine:

• Whether a Pre-Anesthesia Consult Clinic visit is required (virtual or in-person).
• The level of sedation (monitored anesthesia care vs. procedural sedation).
• The facility acuity level (hospital, ambulatory surgery center, or ambulatory endoscopy center).

Quentin Jamieson, Program Administrator for Endoscopy Operations, served as an operational leader on the project. He says, “We worked with many Information Technology teams to embed this risk stratification into the electronic health record and bring our vision to life through existing EHR tools.”

Streamlined procedure orders

A set of standard endoscopy procedure orders replaced the 80+ different ordering methods used by providers across Cleveland Clinic’s northeast Ohio, Akron and south Florida locations. Providers now answer risk stratification questions within these orders, which include relevant patient data from the chart to assist in decision-making.

In situations where the risk stratification process does not indicate a need for anesthesia, providers can request a Pre-Anesthesia Consult Clinic evaluation directly from the order, based on their clinical judgment.

External referring providers submit a request form that uses the same risk stratification questions. These referrals are then transcribed into the EHR as an order for scheduling.

Order-based scheduling

The standard procedure orders enable every scheduler to book at all endoscopy locations, which enhances patient access and enables 24/7 “first-call resolution” through Cleveland Clinic’s Appointment Center. Previously, these appointments could only be made by surgical schedulers with specialized training.

Risk stratification is also embedded into scheduling workflows to help schedulers select the right facility, pre-procedure testing and pre-anesthesia evaluation for self-referred patients.

Additionally, providers can schedule a screening colonoscopy on behalf of their patients while they are still in the office, directly from the signed order. These orders also trigger a “scheduling ticket” to the patient portal so they can book online at a facility with the necessary acuity level at their preferred date, time and location.

Future optimization opportunities

Work will continue to enhance the risk stratification and order process, including standardization of bowel prep instructions. According to Quentin, the EHR presents many opportunities for future enhancements. “This level of standardization improves our reporting capabilities, which will help us better utilize appointment slots and procedure rooms. Next, we will be able to standardize fee scheduling and offer greater price transparency. Lastly, we can use these tools for bulk order placement and patient self-scheduling capabilities.”