Table 2.

Main steps of the pathway for elective surgery before and after redesign

Time period	Clinical pathway before intervention	Intervention	Intended improvement
Before consultation at outpatient clinic	Referrals for elective surgery were sent to various departments. Each surgical department had their own lists of patients who were waiting for a consultation and surgery.	One electronic reception for all referrals for elective surgery.	Waiting list transparent across departments. More unified handling of referrals.
Consultation at outpatient clinic	Patients cleared for surgery were sent home without an appointment for surgery and without a medical pre-assessment.	New routine that clarified the allocation of work between surgical and anesthesia personnel with regard to clinical pre-assessment of the patient.	Earlier and improved medical pre-assessment is known to reduce cancellations.
			Patient participation in planning date for surgery may improve patient satisfaction. Early notice of date for surgery is suggested in the literature as a factor that might reduce no-shows.
	Medical pre-assessment was done the day before surgery.
		Patients participate in planning the date of surgery and obtain the actual appointment while at the outpatient clinic.
Consultation at drop-in anesthesia outpatient clinic at day-surgery center	Not applicable	A new day-surgery center is created within the existing premises.	Improved information flow between surgical and anesthesia personnel may improve the quality of the clinical process.
		Patients cleared for surgery proceed straight to the laboratory for blood sampling and medical pre-assessment at newly established drop-in anesthesia outpatient clinic at the day-surgery center.
		The surgeon’s considerations are written immediately after the consultation so that anesthesia personnel have the preoperative information during the preoperative assessment.
Preparing for surgery	Letter to patient with appointment for surgery. Patient had no influence on appointment time.	Patient receives phone call from hospital 2 days prior to surgery to ensure that he is fit and ready.	Patients get a reminder of their appointment, which can reduce cancellations due to no-shows. If the patient is temporarily ill, then there is time to call a new patient and avoid a cancellation.
	Limited planning between different surgical departments. Each surgical department had their own surgery program that basically was a text file.	One common electronic surgery planning system for all departments. Designated coordinator supervises the planning process between departments.
			One common overview for all departments allows better coordination and planning and might lead to more operations per day. Cancellations caused by facility shortcomings, such as double-booking of the same equipment, may be reduced.
Surgery	Patient showed up for pre-assessment the same day or one day in advance of the planned surgery. Routines varied between departments.	All patients scheduled for elective surgery are received at the day-surgery center. New standardized routines are implemented for pre-surgery preparations.	Centralizing all surgery patients and standardizing routines may reduce variations in the clinical process and thereby improve quality.
After surgery	Patients discharged from different departments with different routines. Discharge letter was not always in hand when the patient left.	All day-surgery patients are discharged from the day-surgery center through new standardized routines.
		Discharge letter is written and given to the patient before discharge.