5 ways to optimize surgical workflows and reduce delays

How smart technology helps providers smooth workflows and improve patient care

A rotator cuff repair is postponed when the payer determines there’s inadequate documentation of failed conservative therapy. Or a clinic is forced to cancel a scheduled epidural at the last minute because the patient takes an NSAID the morning of their procedure.

Slow procedure-room turnovers are no longer the primary cause most of the surgical- and injection-workflow bottlenecks in orthopedic and pain management practices. Instead, the delays that arise today are usually due to issues originating prior to patients’ procedures.

Every orthopedic clinic is familiar with at least some of these upstream and cross-setting culprits. Prior-authorization friction, record-retrieval breakdowns, missteps related to documentation assembly or coordination from clinic to ambulatory surgery center (ASC) — they’re all administrative matters driven by a combination of changing payer requirements and the latest trends in care delivery.

Of primary interest on the regulatory front are a trio of directives from the Centers for Medicare and Medicaid Services. The CMS Interoperability and Prior Authorization Final Rule, the ASC Prior Authorization Demonstration, and the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and ASC Final Rule are all pushing practices to handle coverage checks and documentation requirements before procedures are even scheduled. This comes at a time when much orthopedic care is moving out of hospitals and into outpatient clinics and ASCs — a shift that has drastically increased the need for disciplined coordination across settings.

While it’s a challenging environment for orthopedic practices that will have to adapt their surgical and injection workflows, the good news is this: The infrastructure they’ll need is well established and getting stronger all the time. In 2023, for example, the Trusted Exchange Framework and Common Agreement (TEFCA) created a “network of networks” for health information sharing, and now the number of organizations participating in the initiative is at 9,200 and climbing.¹ Similarly, new technologies like ambient artificial intelligence scribes are helping practices operate more efficiently.² For those that are focused on streamlining their processes to reduce delays and improve patient care, the tools available to ensure operational success are readily available and constantly improving.

Here’s a look at a few of those technologies, and the strategies practices can use to deploy them.

1. Move prior authorization and documentation assembly to the front of the workflow

One of the most common and costly workflow errors in orthopedics and pain management involves waiting to take care of prior authorization and documentation assembly until after a procedure is scheduled.

When practices complete this work at the start instead, they eliminate the chance that a denial or delay will upend their plans for the surgery or injection. They still will have to deal with the last-minute cancellations that arise when a patient suddenly realizes they’re unable to come in. But the cancellation won't happen because the clinic booked the appointment without first ensuring the procedure met the payer’s requirements.

Operationally, this means embedding coverage and authorization processes into patient intake. Make it easy for the front desk to flag the relevant payer requirements up front, and from there, to track authorization status in real time across the clinic and ASC.

2. Be proactive about outside-record retrieval

Another frequent reason for surgical and injection delays is missing imaging, labs, or referral documentation. An MRI taken by a different health system, specialist notes from earlier episodes of care — in many cases, practices are forced to reschedule when these records don’t arrive prior to the procedure.

The solution, again, is to leverage digital tools integrated within the EHR. With Patient Record Sharing (PRS) capabilities, for example, practices can retrieve patient records from other care sites across the country. They can pull data on outside imaging or labs directly into the patient’s chart, and if charts are incomplete, they can flag them for follow up well in advance of the procedure date.

The goal is to make outside record retrieval a defined and deadline-driven step in the pre-procedure workflow. Practices should have a way to easily identify which records are needed for each patient, and they should have a system for automatically tracking when those records are received.

3. Standardize pre-procedure processes

As more surgical and injection procedures shift out of hospitals and into outpatient environments, variation in pre-procedure processes has become the enemy of efficiency for many practices. With multiple teams actively involved in each patient’s individual care journey, everyone has to be on the same page to minimize cancellations and avoidable delays.

Toward that end, coordinating clinics should implement consistent pre-procedure checklists across sites, and they should leverage tools that track pre-procedure readiness to show potential issues as early as possible. They can do so with an interoperable platform that not only connects various care settings, but allows for easy communication between providers and engagement with patients as well. Staff should be able to see what’s missing and what’s not, whether it's lab results or consent forms. They should also be able to do so without toggling between systems, and well before the scheduled procedure date.

4. Optimize clinic-to-ASC handoffs

Along similar lines, when a patient who’s scheduled for surgery or an injection moves from the clinic to the ASC, relevant information must move with them. In many practices, this handoff is still managed through a combination of manual chart exports and faxes and phone calls. But this approach leaves the transition vulnerable to breakdowns and potentially lengthy delays.

Instead, practices should replace cumbersome manual processes with digital workflows that allow the full patient record to be transmitted between settings automatically. With an integrated, cross-setting solution, the clinic and the ASC can gain real-time visibility into everything — prior authorizations, imaging results, clinical notes and pre-procedure clearances.

5. Tighten coordination between scheduling, clinical, and financial workflows

When scheduling, clinical, and financial systems operate in silos, especially across clinic and ASC environments, gaps can emerge very quickly. Then, workflow coordination becomes hard to sustain. Practices can eliminate these disconnects by adopting dashboards that centralize data related to a patient’s procedural readiness. By integrating scheduling with authorization and documentation tracking, they can reduce the chances that something missing throws the entire procedure off track.

Integration and standardization are key

The take-home message for practices eager to address the delays that disrupt their surgical and injection workflows: In a healthcare landscape increasingly shaped by payer requirements and the need for connection across multiple settings, those that prioritize integration and standardization are going to be best positioned for success.

See how athenahealth helps orthopedic and pain management practices tighten surgical and injection workflows.