Problem

1. Problem Cases are found on Day of Surgery to have been mis-identified at some point in the process between the point of Scheduling Request and Registration. Result Preparatory efforts for Day of Surgery are for the wrong patient, recorded on the wrong patient, integrated for the wrong patient, creating delays and potential risk in the delivery of care.

2. Increasing Deployment • of integratedsystems for providing • Peri-Procedural and Peri-Surgical care • Scheduling of all resources and the initiation of planning – it all starts here • Clinical documentation - Prior to Arrival efforts, Pre Anesthesiology, Pre Nursing, Intra Anesthesiology, Intra Nursing, Post Anesthesiology , Post Nursing • Hospital Billing, Anesthesiology Billing • Reporting OC North South L&D IVF, GI, ECT, MRI, CPC, Rad, etc. CPAP BWC SLCH

3. The Anesthetic Plan A preanesthetic evaluation allows for the development of an anesthetic plan, and preparatory testing, that considers all procedural risk and conditions or diseases of the patient that may influence the safe outcome of the anesthetic. Opportunity days between planning and occurrence 5 and under 6 to 14 15 to 30 30 or more Number Scheduled 63 68 33 31 Number Seen in CPAP 17 26 21 20 195 Cases on a given day 84/195 Seen in CPAP within 30 days 101/195 Intubations 67/101 Intubations Seen in CPAP 38 Inpatient > DOS

4. What it takes for Surgical/Procedural Case progression Scheduled Registration in advance of, or on, DOS DOS Case posts in the MetaVision (PreAdmission state which is Inactive) if a MRN is in the Scheduling Message and if not it will post when the MRN shows up in the Registration Message. Occurs prior to arrival as preparation or on DOS End Result interfaced to: Clindesk, IDX Anesthesia, SIS Hospital Billing Interface, Hospital Data Warehouse for State reporting Primary Office Visit Case Inactive Case Active Labs Interface Lab message to MetaVision: Match by MRN. If MRN does not match delete. IMPLICATIONS Blood Bank and Lab results only if MRN Match. Scheduling errors will result in failure to post Clinician review of Clindesk, Labs, History, record findings and plan in MetaVision. NOTE Just opening the record in MetaVision, regardless of Status, requires forever save because of HIPAA IF Active - Automatically pulls in Past Medical and Past Surgical History from Previous MetaVision visit Manual Import of PAP if greater than 30 days Documenting executed care on DOS. IF Active - Automatically imports Last documented Home Medication, Smoking and Alcohol history, OSA, Difficult Intubation , Nursing History. IF Active - Automatically pulls in recorded Allergies from Previous visit

5. Pitfalls to Anecdotal Thinking Failure to Observe Assuming you know what the problem is without seeing what is actually happening Failure to Plan Assuming you know how to fix a problem without first finding out what is causing it Failure to Validate Assuming the action you have taken to fix the problem has worked without