The More We Know the Less We Cancel

Pediatric patients often require sedation or anesthesia for radiology imaging and intervention. At The Children's Hospital of Philadelphia, over 200,000 examinations are performed annually. The goal of the nurse triage role is to call scheduled pediatric patients to obtain accurate history and educate patients and families about what they could expect on the day of service. Planning care according to unique needs minimizes day of service delays and cancellations. Our experiences were such that patients were being cancelled because of npo violations, medical issues requiring anesthesia when sedation was scheduled, and consent issues. Development of this role improved patient care planning; however, day of service cancellations remained significant. Through a quality improvement initiative, it was determined that often patients who cancelled their appointments were not reached by the triage nurse. This increased frustration between staff and parents resulted in inefficient use of radiology imaging. Data were collected daily reflecting the number of sedated outpatients reached. It became apparent that an alternate resource was needed to obtain valid contact information and modifications to methodology around how to reach families after the appointment was already scheduled were trialed. This included changing times of day to achieve higher reach rates. Significant improvement seen in reaching families prior to the day of service. Data were shown reflecting the increase in completed calls on a consistent basis. When this project started on some days, we were at 40%; today we are consistently above 90%, reaching 100% frequently.