Presentation Details
| Transitioning Patient Flow from History and Physical to Consultation: A Win-Win Renee Robinson, Heather Lander, Marjorie Gloff. University of Rochester, Rochester, NY, USA |
Abstract
BACKGROUND: Perioperative medicine clinics (PMCs) must be strategic in triaging patients as demand for preoperative optimization grows. With an aging population, increasing patient complexity, and rising healthcare costs, PMCs must focus resources where they provide the greatest benefit—on complex patients rather than routine preoperative visits. Because additional staffing is often not feasible, systems must align workflows to maximize value.
PURPOSE: In January 2024, Center for Perioperative Medicine launched a quality improvement initiative to replace routine preoperative H&Ps with consultations for our academic medical center (AMC). We used the Plan-Do-Study-Act (PDSA) model and a multidisciplinary team (nursing, anesthesiology, advanced practice providers (APPs), surgery, and administration) The process included outreach to surgical services, redesigning provider templates, developing standardized consultation notes, educating APPs on updated perioperative guidelines, and providing continuous feedback and reinforcement across PDSA iterations.
RESULTS: The clinical pilot began in February 2025. Our PMC serves two hospitals: AMC and a community hospital (CH). The pilot applied only to AMC patients. In 2024, before implementation, we completed 8,875 H&Ps (68%) and 2,115 billable consultations (32%), with 117 additional patients identified after telephone screening as needing in-person assessment. Since February 2025, AMC perioperative visits were converted to billable consultations. All remaining H&Ps are for the CH. This resulted in 4,872 consultations (70%) and 2,115 H&Ps (30%).
CONCLUSIONS: Shifting our PMC from an H&P-driven model to a consultation-focused service improved triage, targeted resources to complex patients, and enhanced value-based care. Although implementation required cultural change, sustained communication, and iterative PDSA cycles, it proved feasible and effective. Our PMC successfully transitioned to a consultation-based model, improving efficiency, enhancing quality, and increasing fiscal value. Next steps include expanding the model to the CH and evaluating the impact on billed revenue, surgical delays, and cancellations.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: In January 2024, Center for Perioperative Medicine launched a quality improvement initiative to replace routine preoperative H&Ps with consultations for our academic medical center (AMC). We used the Plan-Do-Study-Act (PDSA) model and a multidisciplinary team (nursing, anesthesiology, advanced practice providers (APPs), surgery, and administration) The process included outreach to surgical services, redesigning provider templates, developing standardized consultation notes, educating APPs on updated perioperative guidelines, and providing continuous feedback and reinforcement across PDSA iterations.
RESULTS: The clinical pilot began in February 2025. Our PMC serves two hospitals: AMC and a community hospital (CH). The pilot applied only to AMC patients. In 2024, before implementation, we completed 8,875 H&Ps (68%) and 2,115 billable consultations (32%), with 117 additional patients identified after telephone screening as needing in-person assessment. Since February 2025, AMC perioperative visits were converted to billable consultations. All remaining H&Ps are for the CH. This resulted in 4,872 consultations (70%) and 2,115 H&Ps (30%).
CONCLUSIONS: Shifting our PMC from an H&P-driven model to a consultation-focused service improved triage, targeted resources to complex patients, and enhanced value-based care. Although implementation required cultural change, sustained communication, and iterative PDSA cycles, it proved feasible and effective. Our PMC successfully transitioned to a consultation-based model, improving efficiency, enhancing quality, and increasing fiscal value. Next steps include expanding the model to the CH and evaluating the impact on billed revenue, surgical delays, and cancellations.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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