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

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Abstract While computerized provider order entry (CPOE) has become standard for medication, laboratory, referral, and imaging ordering, use in surgical case requests has not been well-described. At a large county hospital, many surgical clinics used a variety of 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. We implemented an OBCR tool 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. We analyzed all cases requested via old or new workflows for 6 months after the go-live of the tool. From 2022 to 2023, managers created 7,226 operative case requests across 19 surgical clinics, 158 faculty surgeons, and 1,737 procedure combinations. Most cases (4,585, 63%) were created via OBCR. Clinic OBCR use ranged from 2 to 97% of created cases. With OBCR, case information was entered earlier, resulting in significantly increased time from case creation to scheduling, 12.0 versus 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). Most surgical clinics at our institution adopted the OBCR tool, facilitating earlier operative case entry with lower void rates. This streamlined case request approach improves preoperative planning and reduces data entry redundancy. The OBCR system also enabled the data collection needed for robust reporting and identification of clinics in need of support or workflow optimization.

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