UC45: Surgical Clearance Coordinator

The Problem

Surgeries are cancelled 2 to 4% of the time on the day of surgery due to missing labs, imaging, cardiology clearance, or unsigned consent forms. These cancellations disrupt the OR schedule, upset patients, and delay necessary care. Coordination of pre-operative requirements 48 hours in advance can eliminate >90% of same-day cancellations.

What the Agent Does

Retrieves surgical schedule (next 48 hours)
For each scheduled case, queries EHR for pre-operative requirements based on procedure type: CPT code and patient risk factors determine required labs (CBC, CMP, coagulation studies), imaging (CXR, EKG), and clearances (cardiology, anesthesia)
Checks chart for completeness: are labs ordered and resulted? Is imaging complete? Are clearance letters signed?
Identifies missing items: generates task list for ordering/follow-up
Sends alerts to: surgical team (what's missing), ordering physician (order labs if not done), patient (required tests if needed), preop coordinator
Monitors task completion in real-time; updates status dashboard
24 hours pre-op: final verification; confirms patient is cleared for surgery

Data Requirements

Primary Data Sources: Surgical schedule (OR block, procedure type/CPT code, patient demographics), EHR labs/imaging/clearances, pre-operative requirement templates (by procedure and risk), patient contact info
Classification: PHI/PII (patient identifiers, surgical procedure, lab results)
Quality Metrics: Completeness verification >95%; false positive rate <2%; case cancellation reduction >80%
Complexity: Medium (workflow orchestration, task tracking, notification management)
Systems: Epic, SurgiNet (surgical scheduling), EHR labs/imaging modules

Score Breakdown

Criterion	Weight	Score (1-5)	Weighted
Time Recaptured	15%	4	0.60
Error Reduction	10%	4	0.40
Cost Avoidance	10%	4	0.40
Strategic Leverage	5%	4	0.20
Data Availability	15%	4	0.60
Process Clarity	15%	4	0.60
Ease of Implementation	10%	4	0.40
Fallback Available	10%	4	0.40
Audience (Int/Ext)	10%	4	0.40
Composite	100%		3.85

Why It Scores Well

Operational Impact: Eliminates OR schedule disruptions; improves OR utilization rate by 2 to 4%
Patient Experience: Prevents surgical delays and cancellations; improves satisfaction
Scalability: Applies to all scheduled surgeries
Implementation Simplicity: Workflow-based; leverages existing EHR data and systems
ROI: OR cancellation costs $3,000 to 5,000 per case; agent cost <$500 per case

Regulatory Alignment

Joint Commission OR Safety Goals: Pre-operative verification (NPSG 07.01.01) is accredited standard
CMS Surgical Care Improvement Project (SCIP): Preventive measures (antibiotic timing, DVT prophylaxis) require pre-operative coordination
HIPAA: Patient identifiers and surgical data are PHI; standard access controls apply
State Medical Board: No additional requirements (agent is operational, not clinical decision-making)

Sprint Factory Fit

2 sprints (surgical schedule integration, pre-operative requirement templates, notification orchestration, preop team interface)

Sprints Required: 2 sprints (surgical schedule integration, pre-operative requirement templates, notification orchestration, preop team interface)
Timeline: 3 to 4 weeks from requirements to pilot
Governance: Preop coordinator and surgical director approval of requirement templates; monitor case cancellation rate weekly
Success Metrics: Pre-operative completeness >95%; case cancellation reduction >70%; preop coordinator satisfaction >4.1/5

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