Implementation and Adoption of an Order-Based Surgical Case Request Tool Across Subspecialty Clinics.

Abstract

Introduction While computerized provider order entry (CPOE) has become standard for medication, laboratory, referral, and imaging ordering, use in surgical case requests is not well described. Our many surgical clinics used varying workflows for case requests, leading to data duplication and data storage outside of the electronic health record (EHR). We hypothesized that a provider-entered order-based case request (OBCR) tool would improve data entry efficiency and provide a more comprehensive EHR audit trail. Methods An OBCR tool was implemented across surgical clinics at a large safety-net hospital system. The existing workflow, whereby clinic managers created operative cases within the EHR after provider communication, remained available. All cases requested via both old and new workflows for six months after the tool went live were analyzed. Results From 2022-2023, managers created 7,226 operative cases across 19 surgical clinics, 158 faculty surgeons, and 1,737 procedure combinations. 4,585 cases (63%) were created via OBCR. Clinic OBCR use ranged from 2% to 97% of cases created. With OBCR, mean time from case creation to scheduling increased significantly, 12.0 vs 0.7 days respectively (p<0.001). Concordantly, mean time from creation to completion increased from 35.4 to 54.6 days (p<0.001). Rates of "voided cases" decreased in the new workflow (1.9% vs 4.5%, p<0.001). Conclusions Most surgical clinics at our institution adopted the OBCR tool, facilitating earlier operative case entry with lower void rates than traditional workflows and improving preoperative planning. OBCR system also enabled data collection needed for robust reporting and identification of clinics in need of support or workflow optimization.