Clinical Team - Anesthesia
How US Anesthesia Eliminated Surgical Cancellations.
SOME CONTEXT:
It's 8:30 AM at an ambulatory surgical center in Rhode Island. The OR is prepped, the patient is in pre-op, and the anesthesiologist opens the chart to find a critical piece of information missing: the patient's clearance from their cardiologist in Florida never arrived. The case gets pushed. The OR sits empty. The patient goes home frustrated.
This scenario plays out constantly in orthopedic surgery, and it's almost always preventable.
At Ortho Rhode Island, one of the largest orthopedic practices in the Northeast, the nursing team decided to stop accepting this as normal. What started as a pilot with two surgeons has now expanded to support all of the practice's operative physicians, and the results have changed how they prepare patients for surgery.
THE problem:
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105 pages, scattered everywhere
Orthopedic surgical patients tend to be complex. Many are older, managing multiple chronic conditions, and seeing specialists across different health systems. At Ortho Rhode Island, the average patient record spans 105 pages - and that's just what they can find.
"Patients are often an unreliable source of their own medical history," explains the clinical team. "They frequently forget renal history, cardiac events, medications, or allergies. It's hard to keep track of things you want to forget!" This is especially true for ‘snowbird’ patients who split time between Rhode Island and other states, with key records sitting in systems Ortho RI couldn't easily access.
Before implementing patients.app, nurses spent their days trawling through multiple provider portals - Brown University Health, Yale New Haven Health, South County Hospital, and others - hunting for cardiology notes, the latest ECHO, or a recent A1C result. When records couldn't be found online, they'd fax requests and wait. And wait.
"I was doing at least an hour of pre-workup before and then making my calls," says Lauren, one of the surgical nurses. "Now I'm doing it maybe in 20 minutes - the whole workup and what I need to collect."
What changed:
What changed: seeing the full picture before the phone call
Patients.app searches EMRs nationally, combines that with what's already in the local EMR, and uses AI to surface exactly what the surgical team needs, in whatever format works for them. For Ortho Rhode Island, that meant custom-built tools for their specific workflows: a Total Joint Replacement Assessment tailored to their evaluation standards, automated EKG checks, and a ‘Clearance Essentials’ view that consolidates the information nurses search for most.
The shift wasn't just about speed. It was about what nurses could now see.
"Patients won't tell me they have a cardiologist or endocrine issues," says Brooke, another surgical nurse. "But I can see it ahead of time and get the right clearances."
Jamie describes finding an anesthesia record for a patient with a history of difficult intubation: "I found it in two clicks. I didn't have to call 4 million places. That was amazing."
The results:
The results: zero last-minute cancellations for clinical reasons
The impact showed up quickly in the numbers. Jennifer Pendergraft, Director of Clinical Operations, tracked cancellation patterns for the four total joint surgeons before and during the pilot.
Before patients.app, the timing of cancellations was a problem: 50% or more were happening within 14 days of surgery - too late to fill the slot with another patient. That meant empty ORs and lost revenue.
During the pilot, something remarkable happened: 100% of cancellations for clinical reasons occurred more than two weeks before the scheduled surgery date. Every single cancelled slot was backfilled. Not a single case was cancelled within 14 days due to clinical reasons.
"We caught a high A1C early and avoided a late-stage cancellation," Lauren notes. The AI flagged what might have been missed, and the team had time to either get the patient medically optimized or reschedule far enough out to fill the slot.
REview:
What the nursing team thinks
The strongest signal might be the simplest one. When asked about working without patients.app, Lauren didn't hesitate:
"Without it, I feel like I'm missing something." Cynthia put it more directly: "It's awesome. It's really changed things for us."
SCOPE:
What this means for orthopedic practices
The challenges Ortho Rhode Island faced aren't unique. Scattered records, unreliable patient histories, time-consuming chart prep, and last-minute cancellations are endemic to orthopedic surgery, and surgical care broadly.
What's different now is that these problems are solvable. The combination of national health information exchange access and AI that can actually read and synthesize clinical information means practices don't have to choose between thoroughness and efficiency. For Ortho Rhode Island, that's meant more time for patient care, more confidence in clinical decisions, and an OR schedule that actually holds.
