July 26, 2023 — Health care providers at the University of Florida College of Medicine and UF Health Shands Hospital perform roughly 30,000 surgeries a year. As a major referral center for the southeastern U.S., the medical hub sees patients who travel for hours and even days to receive care and surgical remedies for all types of illnesses.

With patients taking time off work for scheduled surgeries and staying with loved ones or renting lodging in Florida, a top priority for the health system is minimizing issues on the day of surgery that may cause procedures to be delayed, rescheduled or canceled.

A team of care providers and staff from the UF College of Medicine and UF Health is working to optimize the evaluation of patients prior to surgery as part of an initiative under the patient care pillar of the college’s five-year strategic plan. With the help of a consultant from Johns Hopkins Medicine, the team has overhauled the preoperative evaluation process and pathway in Epic, the hospital’s digital patient record-keeping system, to streamline preparation for surgery, improve recovery times and outcomes, and better support patient satisfaction.

“This is helping patients that come through my clinic get better care — and care that’s more specific to them,” said Josh W. Sappenfield, M.D., an associate professor of anesthesiology and emergency medicine. “It’s a more directed approach to have the right people in the right spot prior to surgery … where we do things that get patients the best outcomes during and after surgery.”

Sappenfield, who previously served as the director of UF’s presurgical clinic and chief of the perioperative medicine division, said he noticed improvements that could be made to the preoperative evaluation process over a year ago. With support and direction from Colleen Koch, M.D., M.S., M.B.A., dean of the College of Medicine, he and other team members have worked diligently to create and test the new clinical pathway.

Now, the team is preparing to roll out their improvements, which include providing more detailed and easily accessible patient notes in EPIC, scheduling a patient for preoperative evaluation at least two days prior to surgery with a trained health care provider, revamping criteria for in-person versus telehealth evaluation based on patient risk and adding time for any necessary patient management prior to surgery.

A patient with diabetes, for example, could need endocrinology to weigh in to ensure healthy blood sugar levels on the day of surgery, said Basma A. Mohamed, MBChB, an associate professor of anesthesiology at UF. Mohamed is succeeding Sappenfield as chief of the division of perioperative medicine and director of the presurgical clinic, soon to be renamed the UF Health Comprehensive Perioperative Optimization Center.

“This is a unique project,” Mohamed said. “We were so lucky to have Dean Koch take leadership over the idea of allowing our patients to be optimized before surgery … It will definitely improve patient satisfaction.”