UC54: Pre-Op Instruction Agent

The Problem

Surgeries are cancelled due to patients eating/drinking before procedures (NPO violations) or missing medication holds. Pre-operative instructions are complex (NPO timing varies by procedure and anesthesia type, medication holds are procedure-specific) and patients often forget or misunderstand them. Timely, personalised SMS reminders improve compliance and reduce surgical cancellations.

What the Agent Does

Patient is scheduled for surgery; pre-op instructions generated based on procedure type and anesthesia plan
Agent sends SMS at intervals: 7 days pre-op ("Surgery scheduled; start preparing. Reply YES to receive detailed instructions"), 2 days pre-op ("48 hours before surgery, please stop eating/drinking per your instructions"), 12 hours pre-op ("NPO starting now; no food/drink after [time]"), morning-of (arrival time, location, what to bring)
SMS includes personalised instructions: medication holds (e.g., "Stop aspirin 5 days before surgery"), NPO timing, what to bring (ID, insurance card), parking/check-in info
Patient can reply with questions or concerns; escalates to pre-op coordinator if complex issues
Links to educational materials: "What to expect on surgery day" video, anesthesia preparation guide
Confirms patient receipt and understanding: "Reply YES if you understand the instructions"
Tracks compliance: day-before call confirms NPO/medication hold compliance

Data Requirements

Primary Data Sources: Surgical schedule, procedure type/CPT code, anesthesia plan (general vs. regional, type of anesthesia), patient medications and allergies, procedure-specific pre-op requirements, patient contact info (cell phone, SMS opt-in)
Classification: PHI/PII (patient identifiers, medication info, appointment details)
Quality Metrics: SMS delivery rate >95%, patient compliance (NPO/medication hold) >90%, patient understanding >85%, cancellation due to pre-op violation reduction >80%
Complexity: Medium (templated SMS workflow, personalisation based on procedure/medications, response handling)
Systems: Epic (surgical schedule), automated messaging platform (Twilio, Amazon Connect)

Score Breakdown

Criterion	Weight	Score (1-5)	Weighted
Time Recaptured	15%	4	0.60
Error Reduction	10%	4	0.40
Cost Avoidance	10%	3	0.30
Strategic Leverage	5%	3	0.15
Data Availability	15%	4	0.60
Process Clarity	15%	4	0.60
Ease of Implementation	10%	3	0.30
Fallback Available	10%	3	0.30
Audience (Int/Ext)	10%	3	0.30
Composite	100%		3.65

Why It Scores Well

Operational Impact: Reduces surgical cancellations; improves OR utilization
Patient Experience: Clarifies expectations; reduces anxiety
Workflow Integration: Asynchronous messaging; minimal clinical burden
Scalability: Applies to all scheduled surgeries
Implementation Simplicity: Templated SMS workflow, standard procedures have well-defined instructions

Regulatory Alignment

HIPAA: SMS must be encrypted; patient must opt-in; audit trail required
FDA: Pre-operative instructions are clinical guidance; no autonomy concerns
State Telemedicine Laws: SMS-based instructions generally do not trigger telemedicine licensing
CMS/Joint Commission: Pre-operative education is care standard

Sprint Factory Fit

2 sprints (surgical schedule integration, pre-op instruction templates, SMS workflow, patient interface)

Sprints Required: 2 sprints (surgical schedule integration, pre-op instruction templates, SMS workflow, patient interface)
Timeline: 3 to 4 weeks from requirements to pilot
Governance: Anesthesia director and pre-op coordinator approval of instruction templates; audit compliance rates weekly
Success Metrics: SMS delivery >95%; patient compliance (NPO/meds) >90%; cancellation reduction >80%; patient satisfaction >4.1/5

Comparable Implementations

Twilio: SMS for healthcare
Epic surgical scheduling modules
Health system pre-operative education programs

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