Pre-Surgical Screening

Overview

Pre-Surgical Screening module and its attendant functionality is intended as a means of standardizing the preparation of patients across an institution or practice to ensure that patients with similar conditions, comorbidities, medications, procedures and of similar age are prepared in a comparable manner appropriate to their condition.  

It supports the ability of an administrative user of Novari ATC to set up the population of automatic preoperative requirements based on the characteristics of the case. Such automatically populated pre-op requirements can be on a system wide basis or be service or surgeon specific. The use of this functionality helps ensure the appropriate and timely preparation of patients.  

In addition to auto-population of pre-op requirements, the functionality supports the transmission of the patients’ need for preparation to the pre-surgical screening clinic or service. The system will automatically send notification to the pre-surgical screening service of any patient for whom a request for a booking has been sent to the OR.

The current status of patients, once sent to pre-surgical screening, can be updated by either the surgeon’s office or the pre-surgical screening service and all changes are shared. As the patient’s status is reviewed by pre-surgical screening service the record is updated and eventually all requirements are noted as complete and at that time the patient is designated as ready.  

Throughout this process both the surgeon’s office and the OR are kept appraised of the patient’s status. This communication is enhanced by a built-in three-way messaging system, specific to a patient, between the surgeon’s office, the pre-surgical screening service, and the OR.  

Steps to Success

1. Novari Health Implementation Team enables PSS module for one or more of your health centers per your site’s configuration requirements.

2. Use Administrator module > Application Settings > PSS Administrator to set up the PSS venue(s), PSS requirements and activities, free days and so on. Your Novari Health Implementation Team will provide guidance during your implementation phase.

3. Use Administration module > Application Settings > Metadata Management Tool, to set up the PSS specific metadata: Preoperative Requirements and Preop Requirement Categories. Your Novari Health Implementation Team will provide guidance during your implementation phase.

4. Use Pre-Surgical Screening module to initially create the appointment blocks used by PSS staff and Provider’s Office staff, when enabled, to book appointments.

Setting Up and Managing PSS

Administrator Module - PSS Administrator

The PSS Administrator is fundamental to the functioning of the Pre-Surgical Screening module and its interaction with Provider’s Office, Care Venue and Patient Registration modules.

It is the responsibility of the person administering PSS to:

• Define PSS Venues and the types of cases they receive.

• Configure the automatic submission of cases to their appropriate PSS Venue.

• Clock off holidays so no appointments are inappropriately scheduled.  

• Define and manage the available values for comorbidities and medications.  

• Define and manage the available values of preoperative activities and preoperative requirements.

• Define appointment resources and associate them with appropriate appointment types.

• PSS Administrator settings are managed by Health Center. This means that any changes made in PSS Administrator only apply to the currently selected Health Center.

To manage the PSS settings and metadata tables:

• From Application Configurations on the Administrator Dashboard, select Application Settings and then select PSS Administrator.

For each of these tables you may add new data or edit the current data.  

METADATA IS CRITICAL TO THE RUNNING OF NOVARI ATC. ONLY MAKE CHANGES TO METADATA WHEN YOU ARE FULLY AWARE OF THE EFFECTS OF THOSE CHANGES. THESE CHANGES TAKE EFFECT IMMEDIATELY, SO ANY MAJOR UPDATES SHOULD BE DONE DURING OFF-HOURS.

Auto Submit Procedure Exclusion

Novari Health Implementation Team configures, based on your care venue requirements, if and when cases are automatically sent to Pre-Surgical Screening. If you chose to have cases sent automatically to PSS, then you can select procedures that should be excluded from automatic submission to Pre-Surgical Screening (PSS). These procedures may still be manually submitted to PSS. For example, if PSS determines that all cataract procedures follow a separate pre-procedural workflow, a submission exclusion can be set for them.

To exclude a procedure from automatic submission to Pre-Surgical Screening:

• Select Auto Submit Procedure Exclusion from PSS Administrator.

• Select a Procedure Category and then click Load Procedures to show all procedures for that category.

• Procedures that are currently excluded from automatic submission to PSS are in the top section. The procedures that are currently automatically submitted to PSS are in the bottom section.

• Procedures can be added to and removed from the exclusions list by clicking Add to Exclusion or Remove from Exclusion.

Comorbidity Type

Comorbidity Type table is a metadata table that stores possible patient comorbidities. These comorbidities can be added to the case record as part of the Add Patient process and follow the case through treatment. Comorbidities are communicated to PSS from Provider’s Office. PSS may also add comorbidities, which will be communicated back to Provider’s Office.

When configured by Novari Health staff for your site, comorbidity types appear on Add Patient and in View

Patient. For example,

Comorbidities included in the General Info & Alerts area of Add Patient form.

You can add, edit, or deactivate comorbidity types by selecting Comorbidity Type from PSS Administrator.  

If an office, for example Provider’s Office or Care Venue, should be alerted when a case has a particular comorbidity, you can associate a Booking Alert Flag for the comorbidity. This can be useful information when booking patients. For example, you might attach an alert to the comorbidity of ‘Insulin Dependent Diabetes’ so that it can be booked as the first case of the day. As is illustrated below, specify which Care Venues should receive booking alerts for a given comorbidity.

Change Active Flag to N to deactivate the comorbidity type. The deactivated comorbidity type is NOT removed from existing patient cases but is not available for new cases.

The Other Flag adds a text box to the comorbidity allowing the Provider’s Office user to add a comment to the comorbidity alert.

Provider’s Office Calendar and Care Venue Day View booking alert indicators that appear when a Booking Alert Flag is enabled on a comorbidity type.

Medication Type

This is a metadata table. The Medication Type table stores a generic categorical description of medications.

These descriptions are not brand specific but rather a category of medication (e.g., Diuretics, Beta Blockers, ACE

Inhibitors, etc.). Medications can be added to the case record as part of the Add Patient process and follow the case through treatment. Medications are communicated to PSS from the provider’s office. PSS may also add medications, which will be communicated back to the provider’s office.

When configured by Novari Health staff for your site, medication types appear on Add Patient and in View

Patient. For example,

Medications included in the General Info & Alerts area of Add Patient page.

Add, edit, or deactivate Medication Types by selecting Medication Type from PSS Administrator. Whenever a medication type is associated with a case, that information will become visible to both the Provider’s Office medical secretary and the Pre-Surgical Screening staff.  

Change Active Flag to N to deactivate the medication type. The deactivated medication type is removed from patient cases.

The Other Flag adds a text box to the medication type allowing the Provider’s Office user to add a comment to the medication alert.

Preoperative Activity Types

Preoperative activity types represent activities which are associated with a case and occur before the surgery.

They can be automatically associated with a case or attached to a case by a medical secretary using Provider’s Office module or the PSS staff using the Pre-Surgical Screening module. PAC appointments and chart prep activities are typical examples of PSS Preoperative Activities.

The Preop Activity Type table stores a list of preoperative activities that can be added by PSS and Provider’s

Office users. These activities are similar to preoperative requirements, but these are managed solely by PSS. Changes to the case relating to the addition, modification, or completion of Preop Activities are relayed back to the provider’s office.  

Preoperative activities can include the ability to book an appointment, for example, a consultation. Other preoperative activities may not need an appointment, for example, chart prep.

Chart prep does not need an appointment whereas RN Initial Assessment does (and has been scheduled).

To create or edit a preoperative activity type:

• From PSS Administrator, select Preoperative Activity Type.  

• Select an existing Preoperative Activity Type to edit it or click Add New… to add a new preoperative activity type for the selected Health Center.

Enter the following information:

1. A description that accurately describes the activity.  

2. The expiry date refers to how long the activity results can be used after the activity has been completed.  

3. Preop Mandatory for Ready Declaration? This indicates whether the defined preoperative activity, once applied to a case, is mandatory as complete in order for the patient to be declared ready for surgery within PSS. This has broader considerations in determining how the PSS module is used. For example, is there a single PSS activity that requires sign-off for the patient to be declared ready, or must each individual requirement be indicated as complete.  

4. Active Flag. Whether or not this activity is available for use and selection by Provider’s Office staff and the PSS staff.

5. Finally, select the appropriate PSS Venue(s) for this activity.

If this activity needs a PSS appointment, then select the Activate Appointment Type checkbox and enter the following information:

1. The Duration, in minutes, of the appointment.

2. The Scheduling Window. This is the period of time in days before the scheduled date that the activity should be completed. Appointments of this type will be limited to the schedule window before the surgery date. This is used by Novari ATC for suggesting appointment dates and PSS Notifications.  

1. Color is used if the activity permits appointment booking. Assigning different colours to appointments of the same type helps PSS users more readily identify the different appointments assigned to a case.  

Appointment Calendar displaying the use of colour to differentiate preoperative activities.  

• Click in the color field to open the colour selector. Choose a dark, neutral or bright colour. Click the colour square to select it and close the colour selector.

DON’T USE BLACK OR VERY DARK COLOURS BECAUSE IT MAKES THE ACRONYM TEXT UNREADABLE.  

• Select Colors in use link to see what colours are already being used.  

1. The Accessibility Acronym. This is used by the PSS Appointment Booking feature and by the PSS Notifications feature. See the images above for an example.

2. Requires Phone Number. Typically reserved for telephone interviews, this setting allows you to indicate that there should be a phone number associated with the appointment. Pre-Surgical Screening staff are prompted to select a phone number when booking the appointment.

Preoperative Appointment Resources

Preoperative appointment resources are the resources which may be needed for an appointment block in PreSurgical Screening module. For example, a Joint PAC could require a physiotherapist, occupational therapist, nurse, telephone, consent waiver, etc. Creating an appointment resource makes requirements for an appointment more explicit to Pre-Surgical Screening staff. Appointment Resources can be created, inactivated, or renamed.

To create or edit appointment resources:

• Select Preoperative Appointment Resources from PSS Administrator.  

• Enter a title for the resource.

• Select if the resource is active or not active.

• Select Save.  

Appointment resources appearing in the Allocated resources section of an appointment block.

Preoperative Appointment Dispositions

The preoperative appointment disposition is the state that the patient’s appointment is in. This is generally used to indicate which patients showed for their appointments and which did not. You can add or deactivate appointment dispositions.

To add a preoperative appointment disposition,

• Select Preoperative Appointment Disposition from PSS Administrator.

• Select New disposition.  

• Enter a meaningful Title.

• Click Save.

These appointment dispositions are available in Pre-Surgical Screening module, PSS Activity Tracking.  

Preoperative Clinical Status

This is the status that is used by the PSS staff to indicate “readiness”, either mandatory or non-mandatory.

In the PSS Administrator, you can add, or inactivate, preoperative clinical statuses through the ‘Preop Clinical Status’ option. You can set which Appointment Disposition will map to which Clinical Status as well as the Clinical Status’ rank -- which determines the order of appearance in dropdowns.  

For a standard Novari ATC implementation, there are four statuses; however, your implementation may have more options.

To add a preoperative clinical status:

• Select Preoperative Clinical Status from PSS Administrator.

• Enter a meaningful Status Name.

• Optionally, select an Appointment Disposition. This creates a cross-reference between the Clinical Status and the Appointment Disposition. Appointment dispositions must exist to appear here.  

• Optionally, select a Colour. Colour choices are none, green, yellow and red.

• Select the Rank. This is where this clinical status appears in the Completed column list.

• Click Save.

Editing Clinical Status; it will cause a case to have the appointment disposition ‘Attended – seen’ and will fill the preoperative activity row with yellow.

The Preoperative activity row in Pre-Surgical Screening Case Details page changes colour to match the colour assigned to the preoperative clinical status that was selected.

PSS Triggers

PSS contains functionality to trigger required preoperative preparation on the basis of case characteristics such as age, co-morbidities, relevant medications, diagnosis, and procedure. These triggers can be applied on a universal basis or confined by conditions such as the service (e.g., Cardiology) or PSS Venue.  

BE SURE TO CAREFULLY CONSIDER ANY PSS TRIGGER. ENSURE THAT THE REQUIREMENTS AND

ACTIVITIES THAT WILL BE AUTOMATICALLY GENERATED ARE PROPERLY CONSTRAINED BY YOUR CONDITIONS TO AVOID UNINTENTIONALLY GENERATING ACTIVITIES AND REQUIREMENTS FOR INAPPROPRIATE CASES.

Through effective use of PSS Triggers, administrators can define how specific conditions result in particular automatically generated requirements. These requirements will be displayed to both Provider’s Office staff as well as PSS staff. The trigger can be applied to existing cases for all patients or patients without a surgery date.

Below is a simple example of a PSS trigger that will cause the activities ‘Consent Received’ and ‘History and Physical Received’ to be attached to cases which match the displayed criteria.

Editing a PSS Trigger to automatically require Consent as well as History and Physical Activities

The following are a couple of examples of how the logic of the conditions for the PSS Triggers are applied. Basically, multiple selections of a single condition, like ‘Diagnoses’, act like a logical ‘this OR that’; while different conditions, like ‘Medication Type’ and ‘PSS Venues’, act like a logical ‘this AND that’.

To create a PSS trigger:

• Select PSS Triggers from PSS Administrator.

• Select New PSS Trigger.  

• On the PSS Triggers – New PSS Trigger page, carefully read the instructions.

• Select the Care Venue that this trigger applies to.

• Create a descriptive PSS Trigger Name.  

• Set the trigger as Active.

• Click Save.

You will be returned to the PSS Triggers page. Locate the trigger you created and click it to continue building your trigger.  

• Choose if the trigger is to be applied to all patients or patients without surgery date.  Triggers can be applied to all cases, regardless if they are scheduled or not, which may affect the scheduled cases readiness for surgery, as they are already booked. Or they can be applied to only cases without surgical dates; this could also affect the readiness status but is easier to manage as the cases are not currently scheduled.

• Select the Preoperative Requirements and Preoperative Activities that will be applied to the cases that satisfy the trigger’s conditions. The requirements and activities must be defined before creating a trigger.

• Specify the Conditions required to apply these requirements and activities to a case for this Care Venue. (These are standardized categories for which PSS Triggers can be fired. They are not configurable.)

• Click Save.

How the Logic of Triggers is Applied to Cases

Consider a PSS Trigger with the following criteria selected:

• Providers ‘Alpha’ and ‘Beta’.

• Procedure ‘Gamma’.

In order for this trigger to be applied to a case, either provider Alpha OR Beta must be the most responsible provider for the case, AND the procedure selected MUST be ‘Gamma’. Below is a table representing possible values and whether or not the trigger is applied.

PSS Trigger Exclusion List

The PSS Exclusion List is designed to work in conjunction with the PSS triggers to ensure that certain PSS Activities/Appointment Types are applied correctly in situations where they are mutually exclusive.

EXCLUSION LISTS ARE HELPFUL BUT CAN BE UNNECESSARILY COMPLEX. ONLY CREATE AN EXCLUSION WHENEVER TWO ACTIVITIES TRULY ARE MUTUALLY EXCLUSIVE. IF THERE IS ANY REASON WHY TWO ACTIVITIES WOULD BOTH BE REQUIRED FOR A CASE, THEY SHOULD NOT BE PLACED ON THE SAME EXCLUSION LIST.

In the example below, Anesthetist Review and Consent Received are placed on an exclusion list. Anesthetist Review takes priority, so if it is present on a case, Consent Received will never be automatically added to the case. This is a proper exclusion if your ‘Anesthetist Review’ would ALWAYS render the ‘Consent Received’ Activity unnecessary or inappropriate.

Now for a more concrete example: it is highly unlikely that ‘Nurse Review – By Telephone’ and ‘Nurse Review – In Person’ should both be applied to a case through the PSS Triggers functionality. These two options are most likely good candidates for an exclusion list.  

A case with the Anesthetist Review activity will never have the Consent Received activity added through PSS Triggers

Deactivating a PSS Trigger

When you deactivate a PSS Trigger that was active, you must indicate what to do with the existing PSS activities and requirements on active cases.

• Choose to leave or remove the PSS activities and requirements on cases with surgery dates.

• Choose to leave or remove the PSS activities and requirements on cases without surgery dates.

• Click Save.

PSS Venues

PSS Venues are specific to a Health Center. When adding a new venue (or editing an existing venue), it is possible to set appropriate activity types and control who is capable of scheduling and signing-off on activities and requirements.

THE PSS VENUE MANAGER IS RESPONSIBLE FOR WHAT IS AVAILABLE WITHIN A PSS VENUE AND WHAT ACTIONS CAN BE TAKEN BY USERS WITHIN THAT VENUE. THE LOGIC TO DETERMINE HOW CASES ARE SENT TO PSS VENUES IS DETERMINED BY THE NEXT SECTION, PSS VENUE RULES.

To create a new PSS Venue:

• Select PSS Venues from PSS Administrator.

• Select New PSS Venue.  

• On the Edit PSS Venue page, enter a name for the PSS Venue.

• Choose if providers can schedule PSS appointments. When Yes is selected, Provider’s Office staff can book PSS appointments.

• Choose who can sign-off preoperative requirements and/or can select the Results Received checkbox. Choices are PSS, Provider, Both.

• Select all the Allocated Activity Types appropriate to this PSS Venue. By default, all are selected for your convenience.  

o Note: Activity Types may not exist when you create a PSS Venue because creating your PSS Venue should be the first step undertaken. In that case, create the PSS Venue, create the Activity Types, and then edit the PSS Venue and allocate the Activity Types.

• Click Save.

To edit a PSS Venue:

• Select PSS Venues from PSS Administrator.

• On the PSS Venues page, click the name of the PSS Venue you want to edit.

• On the Edit PSS Venue page, make your edits.

• Click Save.

The Dental PSS Venue will not allow providers to schedule appointments and will include two activities.

PSS Venue Rules

PSS Venue Rules are used to direct patients to the proper PSS venues based on patient age, procedure, diagnosis, and by which care venue the patient is assigned to. The rules can be saved in an order of precedence by dragging one of the rules above or below another.  

The PSS Venue Rules apply to a PSS Venue within a health center. The PSS Venue must exist prior to creating a rule.

THE PSS VENUE RULES WILL BE EVALUATED FROM TOP TO BOTTOM. IF A CASE MATCHES THE FIRST RULE, IT WILL NOT BE EVALUATED BY ANY OF THE RULES BELOW IT.

There are two different rule sets which will send matched cases to PSS Venue 1

To create a PSS Venue Rule:

• Select PSS Venue Rule from PSS Administrator.

• Select New PSS Venue Rule.  

• In PSS Venues – New PSS Venue Rule, select the PSS Venue to assign the cases to.

• Click Save.

• The new rule is added. Click the edit icon in the new rule to edit the conditions for this rule.

• Click the red ‘X’ icon to delete a rule.

In the PSS Venues – Edit PSS Venue Rule page:

• Optionally add an age criterion. Click Add Age  and enter the age range in the Age dialog.  

• Optionally, select one or more diagnoses. Filter the list of diagnoses by selecting a Service. Select a diagnosis in the Available pane and click the >> Move button. Use CTRL+click and SHIFT+click

(CMD+click) to select multiple diagnoses. To remove a diagnosis, select it in the Selected pane and click the << Move button.

• Optionally, select one or more procedures. Filter the list of procedures by Service and/or Procedure Category. Select a diagnosis in the Available pane and click the >> Move button. Use CTRL+click and SHIFT+click (CMD+click) to select multiple diagnoses. To remove a diagnosis, select it in the Selected pane and click the << Move button.

• Optionally, choose if the rule applies to existing cases for all patients or only patients with no surgery dates.  

• Click Save.

• The rule is updated, and a summary of its rule criteria is displayed.

WE STRONGLY ADVISE YOU TO CAREFULLY CONSIDER THE CONSEQUENCES OF ALTERING/CREATING PSS TRIGGERS AS THEY CAN INADVERTENTLY AFFECT HUNDREDS OF CASES.

To rearrange the order of the rules:

• Select PSS Venue Rules from PSS Administrator.

• On PSS Venue – Rule page, click and hold your mouse pointer on a rule and drag it up or down to reposition it

• Click Save rules order.

Free Days

You can create free days to prevent PSS users from scheduling appointments for specific dates, such as national or local holidays, or any days when the PSS Venue is not capable of accepting appointments.

Free days apply to a PSS venue. If you have more than one PSS venue and you are adding statutory holidays, for example, ensure you add them to all PSS venues.

It is recommended you create the free days before PSS users create the appointment calendars because you cannot create a free day on a day that contains appointments.

• From PSS Administrator, select Free Days.

• Select New free day.

• In Free days – Edit Day, select a PSS Venue.

• Click in the Date field to open the calendar and then select a date.

• Click Save.

You cannot delete a free day, but you can deactivate it, so it no longer blocks appointments being booked for that day.

To deactivate a free day:

• From PSS Administrator, select Free Days.

• Click the date for the free day you need to deactivate.

• In Free days – Edit Day, select the Active option No.

• Click Save.

Administrator Module - Metadata Management Tool

Preop Requirement Category and Preoperative Requirements

Preoperative Requirements are the tests which should be completed before the date of surgery. These are added by PSS staff or Provider’s Office staff.

Preop Requirement Category and Preoperative Requirements tables are located in the Metadata Management Tool, not in PSS Administrator. Preoperative requirements can be used independent of Pre-Surgical Screening if Provider’s Office users want to manage their own. For example, as a Provider’s Office user you can send a patient for bloodwork or x-rays to a local clinic and then ensure that the results back before surgery.

Preoperative Requirements are specific to care venues.

Preoperative Requirements must belong to a Preop Requirement Category.

To manage preoperative requirements:

• From Application Configurations, select Application Settings and then select Metadata Management Tool.  

To add or edit a Preop Requirement Category:

• Select Preop Requirement Category from Metadata Management Tools.

• Select Add Category to add a new category.

• Select an existing category to edit it or deactivate it.

• Click Submit.

To add or edit a preoperative requirement:

• Select Preoperative Requirement from Metadata Management Tools.

• Select Add Requirement to add a new requirement.

• Select an existing requirement to edit it or deactivate it.

• Click Submit.

When creating or editing a preoperative requirement, you must:

1. Provide a description. Be descriptive because this is what is shown to Provider’s Office and Pre-Surgical Screening staff.

2. Associate the requirement with the appropriate requirement category.

3. Specify the expiry of the requirement, in days. Enter zero (0) if the requirement doesn’t expire.

4. Specify if the schedule date is displayed or not and whether or not it is required. As an example, if a CT is required, do they need to enter the date for which it is booked? In most workflows, offices would not know the date of the CT scan when booking the procedure.

5. Specify whether this requirement must be completed in order to consider the case ready for surgery.

6. Specify the Other Flag value. If it is set to ‘Y’, an input box will be available to the PSS users so that they may enter additional information.

7. Specify the Care Venues for which this preoperative requirement is appropriate.

Adding a blood glucose requirement, which belongs to the Biochemistry requirement category  

The list of preoperative requirements grouped by category presented to Pre-Surgical Screening staff when adding a preoperative requirement to a patient’s case.

Attached Document Type

As the Novari ATC administrator, you can set attachment document types to be associated with Preoperative Requirements/PSS activities. For example, the document type, Blood work, can be associated with the Preoperative Activity RN Review. When RN Review preoperative activity is added to the patient’s case, the Attachment paperclip icon appears and, when clicked, opens the Blood work attachment.  

This saves the PSS staff some time. The document they need is available on the requirement or activity, so they don’t need to search through the list of attachments to find the one they need.

How it works:

• The attachment document type is associated with a preoperative requirement and/or a preoperative activity.

• If the document has been attached to the patient’s case and been assigned the document type, when the preoperative activity or preoperative requirement is added to the case, then the Attachment paperclip icon appears in the requirement or activity.

• When the preoperative requirement or preoperative activity has been added to the patient’s case, but the document has not been attached to the patient’s case, when the document is attached and is assigned to the document type, then the Attachment paperclip icon appears in the requirement or activity.

Pre-Surgical Screening Module

Appointment Blocks

1. A descriptive label for the block which will make it easy to find later.

2. The number of slots, which is equivalent to the number of patients that can be booked concurrently. This is typically related to the number of rooms.

3. The number of cases greater than the number of slots which can be booked. This can be used for managing last minute patients. This is a mandatory field, and the value must be between 0 and 10 inclusive.

4. The maximum number of minutes the block can be overbooked. This is useful in proactively defending against the misuse of the overbook feature. This applies to the whole block.

5. A start and end time for the availability of the room. Note that this range must be divisible by the time length of the appointment type. (If there are many appointment types, it will be the greatest common divisor). Click in the date field to open the calendar.

6. How often this block repeats (in weeks) and on which days it will be available.

7. From which date the block will begin and on which date it will end.

8. The resources that will be available to the rooms. (Resources are managed in PSS Administrator.)

9. The appointment types that are managed by this Appointment Block. (Appointment Types are managed in PSS Administrator.)

To create PSS appointment blocks, please see Appointment Blocks in the Pre-Surgical Screening Module section of this user guide.

PSS in Provider’s Office Module

When Pre-Surgical Screening module has been enabled at a health center, changes happen in the Provider’s Office module to facilitate the transfer of PSS information about a case between the Provider’s Office staff and PSS staff.

The Pre-Surgical Screening (PSS) functionality, incorporated in Provider’s Office module, is intended as a means of standardizing the preparation of patients across an institution or practice to ensure that patients with similar conditions, comorbidities, medications, procedures and of similar age are prepared in a comparable manner appropriate to their condition.

It supports the ability of an administrative user of Novari ATC to set up the population of automatic preoperative requirements based on the characteristics of the case. Such automatically populated preoperative requirements can be on a system wide basis or be service- or surgeon-specific. The use of this functionality helps ensure the appropriate and timely preparation of patients.

In addition to auto-population of preoperative requirements, the functionality supports the transmission of the patients’ need for preparation to the pre-surgical screening clinic or service. The system will automatically send notification to the pre-surgical screening service of any patient for whom a request for a booking has been sent to the OR via Care Venue module.  

The status of patients, once sent to pre-surgical screening, can be updated by either the provider’s office or the pre-surgical screening service and all changes are shared.

As the patient’s status is reviewed by pre-surgical screening service the record is updated and eventually all requirements are noted as complete and at that time the patient is designated as ready.

Throughout this process both the provider’s office and the OR are kept appraised of the patient’s status. This communication is enhanced by a built-in three-way messaging system, specific to a patient, between the surgeon’s office, the pre-surgical screening service and the OR.

Pre-Surgical Screening Permissions and Automation

Your Novari ATC site administrator configures how PSS is enabled based on your organization’s workflow and design decisions. Your administrator creates the PSS venues, the list of comorbidities, medications, the preoperative requirements, the preoperative activities, appointment resources and dispositions, and identifies the days in the year when appointments cannot be booked.

Your administrator configures who has permission to sign off on preoperative requirements/results received

(PSS, Provider or both), if Provider’s Office staff can schedule PSS appointments, and if patients are automatically sent to PSS, which PSS venue if more than one, when and under what conditions.  

All these configuration decisions affect what you see in Provider’s Office and what you can do.

Pre-Surgical Screening and the Add Patient Page

When Pre-Surgical Screening is enabled, you may be required to fill in two additional sections in General Info & Alerts depending on how your Add Patient page has been configured: Comorbidities and Relevant Medications.

Note: your General Info & Alerts area may differ from what is shown below because of your unique configuration requirements and the care venue selected for this patient. Not all care venues are associated with a pre-surgical screening venue.

Comorbidities  

• A Yes or No answer is required.  

• If you select the Yes option, the Comorbidities dialog appears. Select the relevant comorbidity or comorbidities and then click Update.

An example of comorbidities.

Relevant Medications

This is not intended to be a record of the patient’s precise medications but a notification that the patient is taking medications that might have a bearing on the conduct of the surgical procedure or the anesthetic.

• A Yes or No answer is required.  

• If you select Yes option, the Medical Alerts dialog appears. Select the relevant medication or medications and then click Update.

Pre-Surgical Screening and View List Page

When PSS is enabled and associated with one of your care venues (if your surgeon uses more than one), you will see the PSS Status column added to View List. This column indicates the PSS preparation status of each patient on your wait list. It combines the PSS Status and PAC Appt. Date fields from View Patient into one convenient column.

PSS Statuses

• ‘NA’ no appointments. This indicates the patient does not have any appointments.

• No coloured background. This indicates that the patient case has not been sent to a PSS.

• ‘Sent’ coloured red. This indicates that the patient’s data has been sent to Pre-Surgical Screening but has not been reviewed.  

• ‘Received’ coloured yellow. This indicates that the patient’s data has been sent to Pre-Surgical Screening and has been reviewed.  

• ‘Ready’ coloured green. This indicates that the data has been sent to Pre-Surgical Screening, has been reviewed and that the patient is prepared for surgery.  

• Indicates that all the patient’s appointments are scheduled.

• Indicates that some or none of the patient’s appointments are scheduled.

• Allows you to schedule the patient’s appointments using the PSS Mini Scheduler.

PSS Status Actions

You can sort View List by PSS Status. Click the column heading once to sort in ascending order: Ready, Received, Sent, Not Sent. Click a second time to sort in descending order: Not Sent, Sent, Received, Ready.

Click NA to open the patient in Pre-Surgical Screening Case Management. The Case Management page is described below.

Click the calendar icon to open the PSS Mini Scheduler, described below.

Pre-Surgical Screening and the Case Details Page

When Pre-Surgical Screening is enabled, there are several changes to the Case Details  page.

Note: your Case Details page may differ from what is shown below because of your unique configuration requirements and the care venue. Not all care venues are associated with a pre-surgical screening venue.

PSS Status

This field indicates if the patient has been sent to PSS, if the case has been reviewed or if the case is prepared.

Depending on how Pre-Surgical Screening has been configured, your patients may be automatically sent to PSS when you add them to the wait list or when you schedule the patient’s case. Alternatively, you many need to manually send a patient to PSS.

• When a patient has not been sent to PSS, there is no colour and there is the Send action allowing you to manually send the patient to PSS using the Pre-Surgical Screening Case Management page.

• When a patient has been sent to PSS, the status changes to Sent and is coloured red.

• When a patient’s case has been reviewed by PSS, its status changes to Received and is coloured yellow.

• When the patient is prepared, the status changes to Ready and is coloured green.

To viewing the patient in PSS Case Management page,

• Click the field heading to open the patient’s case in Pre-Surgical Screening Case Management.

PAC Appt. Date

Some patients may need to attend a pre-assessment clinic appointment. You may be able to schedule the appointment depending on how PSS is configured, or the appointment may be scheduled by PSS staff.

• Displays NA if the patient does not have a PAC appointment date. When NA is hyperlinked, you can click it to open the patient in Pre-Surgical Screening Case Management and, depending on permissions, may be able to add a Preoperative Activity. Note: not all Preoperative Activities have appointments.

• Displays a red X and a calendar icon if the patient needs an appointment but the appointment hasn’t been scheduled.

• Displays a green checkmark and a calendar icon when the patient’s PAC appointment has been scheduled.

• Displays a red exclamation mark and a calendar icon when the PAC appointment is outside the scheduling window.

Comor Alerts

• These are the comorbidities that were selected while adding a patient to your wait list.

• The number indicates the number of selected comorbidities.

• Click Comor Alerts to open Comorbidities dialog to view or edit the comorbidities.

Med Alerts

• These are the medications that were selected while adding a patient to your wait list.

• The number indicates the number of selected medications.

• Click Med Alerts to open Medical Alerts dialog to view or edit the medications.

Pre-Surgical Screening Case Management Page for Provider’s Office Users

With Pre-Surgical Screening enabled, Provider’s Office users can view a patient in the Pre-Surgical Screening Case Management page. You can document and manage details about the case in real-time. Once the case has been sent to PSS, all changes made to this page are interactive with changes made by the PSS office. Should PSS staff add requirements, an electronic message is sent to the provider’s office using Novari ATC secure messaging (Please read the Novari ATC Getting Started and User Preferences User Guide to learn more about messaging). Should Provider’s Office staff add preoperative requirements, notification messages are automatically sent to PSS.

The PSS Case Management Screen when opened from Provider’s Office.

To open the Pre-Surgical Screening Case Management page, do one of the following:

• From View List, click the NA hyperlink in the PSS Status column.

• From Case Details, click PSS Status field heading.

• From Case Details, click the NA hyperlink in the PAC Appt. Date field.

• From Case Details, click the calendar icon in the PAC Appt. Date field. In PSS Appointment Scheduling, click View in PSS.

• Select Preoperative Requirements from Preop in the Provider’s Office navigation menu and then click a patient’s name.

• Select Preops Audit from Tasks in the Provider’s Office navigation menu and then click a patient’s name.

Patient Preparedness Status

The patient’s current state of preparedness is displayed at the top of the Pre-Surgical Screening Case Management page.

You need to manually send the patient to PSS.

One or more requirements or activities need to be completed by Provider’s Office or Pre-Surgical Screening staff.

All requirements and activities are complete.

Pre-Surgical Screening staff has overridden requirements or activities to mark the patient as prepared for surgery.

You can send the patient to PSS by clicking Send to PSS.

If the patient has been sent to PSS, you can recall the patient by clicking Recall.  

You may want to recall a patient from PSS, for example, if a case is cancelled and is not receiving surgery for several months. You may want to recall it to not clutter the PSS list of cases. Perhaps the patient no longer requires any PSS activities or requirements to be "ready" for surgery, or you may need to add/remove/ignore PSS activities or requirements and want to make those changes before sending the case to PSS again.

Preparations & Alerts

This area displays the preparations and alerts that may have been added during the Add Patient process, or subsequent edits to the patient case using View Patient.

Note: Your list of Preparations & Alerts may differ from what is shown below because of your unique configuration requirements.

Preparations & Alerts area of the Pre-Surgical Screening Case Management page. Your area may be different from what is shown.

To modify a preparation or alert:

• Click ASA Class to open the ASA Class dialog to change the patient’s ASA class.

• Click Comorbidities to open the Comorbidity Alert dialog to view or edit the comorbidities.

• Click Patient Alerts to open the Patient Alerts dialog to view or edit the patient alerts.

• Click Medication to open the Medical Alerts dialog to view or edit the medications.

• Click Attachments to open the Document Attachment dialog to scan or upload a document. For information on scanning or uploading Attachments, please read Novari ATC Provider’s Office User Guide.

• Click Edit to edit the attachment document type.

• Click Deactivate to deactivate the attachment. Show deactivated attachments to see them.

Click Reactivate to reactivate them.

Procedural Information

This is a summary of the patient’s procedural information. You can view/print the OR Booking Form. Any changes to the detail information must be done in View Patient.

Preoperative Requirements and PSS Preoperative Activities

This section displays the preoperative requirements and preoperative activities that need to be completed for the patient to be deemed prepared.

As a Provider’s Office user, you may add and delete preoperative requirements and activities.  

There are two sections: one for preoperative requirements and the other for PSS preoperative activities.

For this patient, only PSS staff can mark results received and manage the Completed status.

Icon Legend

Date of Requirement

You can optionally edit dates assigned to requirements if a requirement or activity has an optional or mandatory date. Some requirements and activities may not display a date field.

To add or edit a date, do one of the following:

• Click in the date field and enter a date using the format displayed.

• Click the calendar icon, navigate to the desired month, and click the day.

Activities may have appointment dates if the Preoperative Activity was defined as being schedulable by your Novari ATC administrator. As a Provider’s Office user, you may have permission to schedule a preoperative activity appointment date.

Results Received and Completed

Your ability to indicate that results have been received and to change the Completed status is controlled by the PSS venue configuration. Permission to mark results received and manage the Completed status can be granted to PSS, Provider or both.

Results Expire

If a requirement has an expiration associated with it, the date will be displayed once the Date of Requirement is entered. Novari ATC automatically resets the status of a case should results expire. Requirements and activities may have expiry dates. For example, blood work results may expire after 180 days. These expiries are specified by your Novari ATC site administrator.  

The Blood Glucose (On Admission) expires in 180 days. When the date of requirement is entered, the results expiry date is calculated.

View History

You can view a patient’s history from the Pre-Surgical Screening Case Management page. This is the same patient history that you can view from View Patient screen by selecting Change History from View Patient Actions.

To view a patient’s history:

• Click View History from the top or the bottom of the patient’s case.

Scheduling an Appointment

You may schedule an appointment date and time for a PSS Preoperative Activity. Depending on how you or your Novari ATC administrator have configured the appointment blocks, you may see a recommendation you can choose, or you can manually schedule the appointment.

To schedule an appointment, do either of the following:

• Click the calendar icon in the Appointment column in the Pre-Surgical Screening Case Management page.

• Click the calendar icon in View List.

• In Case Details, click the calendar icon in PAC Appt. Date field.

• In Appointment Scheduling, select the recommendation or click Schedule Manually.

• When you select Schedule Manually, Schedule appointment opens and includes the patient’s name and the preoperative activity.

• If the preoperative activity has a scheduling window defined, that is displayed as well.

• The days when the preoperative activity can be scheduled are indicated in the calendar.

Anaesthetic Consultations can only be booked on Tuesdays.

• Navigate to a date and select an open timeslot by clicking Book.

Cancelling or Rescheduling an Appointment

You can cancel a scheduled PSS appointment or reschedule it.

• Click the calendar icon for the scheduled preoperative activity.

• In PSS Appointment Scheduling, select Cancel or Reschedule.

Triggering Preoperative Requirements and Preoperative Activities

Optionally, your Novari ATC site administrator may have created PSS triggers that automatically add requirements or activities to a patient based on a condition. For example, a stress test may be required for all patients 60 years of age and over. When this happens, you see a red notice at the top of the Pre-Surgical Screening Case Management page. The requirement or activity is added, and the patient’s history records the auto generation.

You can manage your patient’s preoperative requirements by selecting Preoperative Requirements from Preops on the Provider’s Office navigation menu. This page displays all the patients on your wait list with outstanding preoperative requirements that need to be managed.

Preoperative requirements are used to track any outstanding “things that need to be completed” prior to the patient receiving surgery. Use of preoperative requirements ensures that you can know the patient’s current state of readiness at a glance.

Preoperative Requirement List

The Preoperative Requirement List displays the outstanding requirements that need to be completed to ensure a patient is fully prepared before the surgery date. Only incomplete (Not Completed) preoperative requirements are displayed.  

Preoperative requirements that are past the Date of Requirement are highlighted in red.

The list is presented in order by patient name. You can change the sort order by clicking on a column heading Clicking once sorts the list in ascending order. For numeric columns, such as MRN, the smallest number is first, and the largest number is last. For Date of Requirement, the ascending sort is by requirements with dates, followed by requirements without dates. The dates are in chronological sequence with the earliest date first.

You can change the number of records displayed by selecting a number from the predefined list in Results Per Page.

Completing a Preoperative Requirement

When you mark a preoperative requirement as Reviewed, Hold or Reviewed, Complete, it is removed from the Preoperative Requirement List and its status is displayed when you view the patient in Pre-Surgical Screening Case Management.

Note: Once a requirement is complete, it cannot be deleted.

Preoperative Requirement Filter

If you have many outstanding preoperative requirements, you can filter the list to focus on specific requirements or by forthcoming surgery dates, for instance.

• Select the filter criteria you need and then click Apply Filter.

• To remove the filter, click Reset All.

When you apply a filter, the filter values appear at the top of the Preoperative Requirements List.

Pre-Surgical Screening Module

Pre-Surgical Screening (PSS), an optional module that can be added to Novari ATC, addresses the issues of patient preparation for procedures. These issues include standardization of preparation, monitoring of completion and communication of required preparation between provider’s offices, pre-procedural clinics and the operating room. The objective of the PSS module is to ensure that all patients are prepared to an agreed standard, preparation is completed in a timely manner, and the state of completion is shared by all parties involved in the care of the patient.

The Novari ATC Pre-Surgical Screening module is used to track patients preoperatively through to their surgical procedure. Using this robust functionality, Pre-

assessment staff will be able to view procedure bookings, identify or schedule any required testing or appointments, and track and view any required documentation.

The PSS module adds to the data collection on the patients to include information on co-morbidities and medications that influence the preparation of patients. It provides a view of the state of patient preparation for a pre-surgical screening clinic. Patient information is presented at an appropriate period before a scheduled procedure.  

Documentation of the process of pre-surgical screening and the notation of additional required investigation by the preoperative clinic is also supported. The status of the preparation of the patient in this process is available to the provider and the OR staff. In addition, a patient specific messaging system between Provider’s Office, Care Venue, Patient Registration and PSS staff is included.

Navigation Menu

Patient Search

The patient search helps you find a patient who has been sent to Pre-Surgical Screening. You can search by MRN, patient name, HCN or phone number. When searching by patient name, you can choose to search for a name that starts with the characters you have entered or, by clearing the Starts with checkbox search for a name that contains the characters.

Readiness Calendar

When you first open Pre-Surgical Screening module, the Readiness Calendar is displayed. This is your main working area. It shows a summary of patients who are in the process of being optimized for surgery. By default, groups of patients are organized by their surgery date, with patients who currently have no assigned surgery date listed on the right-hand side of the page. This is your primary working area. From here you can look ahead to forthcoming months, drill down on a specific day to see the cases for that day and see if there are any notifications to be cleared.  

Legend

• Green squares indicate the number of patients who are currently prepared for that surgery date.  

• Yellow squares indicate patients who are in the process of being optimized for that surgery date.

• Red squares show patients who have not yet been reviewed by PSS staff for that surgery date.  

• Grey indicates the total number of patients sent to PSS with surgical procedures scheduled for that day.

Changing the PSS Venue

If your site has more than one PSS venue, you can switch from one PSS venue to another by selecting the PSS venue at the top right-hand corner of the PSS page.

You can specify your preferred PSS venue as the default PSS venue in User Preferences.

Navigating Dates

The Readiness Calendar opens to the current month and displays the next two months.  

To navigate forward and backward in time:

• Click the single chevron to move back or forward one month at a time.  

• Use the double chevron to move a year back or forward.

• Click the down arrow beside the current month to navigate quickly to a specific month within five months before or six months after the current month.

• Click the side calendar heading to move to that month.

Readiness Calendar Notification Alert

If the surgery date has changed for a case previously submitted to PSS, if a case previously submitted to PSS has been removed from the wait list without having received surgery, if there are appointments created outside of the scheduling window (see PSS Appointments to learn about scheduling windows), or there are mandatory appointments which are unscheduled, you see the notification area listing the items at the top of the Readiness Calendar.

To view and action the notifications, do one of the following:

• Click here link in the notification area at the top of the Readiness Calendar.

• Select PSS Notifications from the PSS menu.

Patients List

The Patients List displays PSS patients who are ready, are in progress or who have not been reviewed by PSS staff.

There are several ways of viewing the list of PSS patients: for the month, a week, a specific day or a specific state of readiness.

To view a list of patients for the month:

• Click the month icon at the top left corner of the Readiness Calendar.

To view a list of patients for the week:

• Click the week icon at the left of the week of interest.

To view a list of patients for a day regardless of status:

• Click the day number.

To view a list of the patients for a specific day filtered by status:

• Click the corresponding coloured square on the date of interest. You are presented with the view list filtered by those patients. For example, if you clicked the red square, the view list displays the three patients who are not ready for surgery. If you clicked the green square, the view list displays the one patient who is ready for surgery. If you clicked the grey square, the view list shows all patients, regardless of their readiness for surgery for that date.

Four patients, one of whom is ready, three of whom have not yet been reviewed by PSS.

To view a list of patients who are ready, in progress or have not yet been reviewed by PSS staff:

• Click the corresponding coloured square in the Summary Totals area on the right-hand side of the Readiness Calendar.

To view a list of patients who have been sent to PSS without surgical dates:

• Click the corresponding coloured square in the Without Surg Date area on the right-hand side of the Readiness Calendar.

You can also navigate to View List by selecting View List from the PSS menu. Novari ATC PSS module remembers the last View List you were on during the current session. For example, if you had last navigated to View List from the month calendar icon, when you select View List from the PSS menu, it displays View List for the month. This is helpful if, for example, you have navigated to the patient detail page and want to quickly return to your View List. The View List filter persists while you are signed in or until you reset the filter criteria.

View List Columns, Statuses and Actions

By default, the View List is sorted in ascending order by Current Surg Date, that is, a patient with a surgical date closest to today’s date is first and a patient with a surgical date the farthest in the future is last.

You can click on all column headings to change the sort sequence. The first time you click a column heading that has not already been used to sort the list, the list is sorted in ascending order by that column. Clicking the column a second time changes that column to descending sort sequence.

Status/Appt column

• Displays the PSS appointment status.

• Red x and a calendar icon when an appointment needs to be scheduled.  

• Green checkmark with a calendar icon when the appointment has been scheduled.

• NA when no appointment is needed.

• Click the calendar icon to open PSS Appointment Scheduling to schedule an appointment or change an existing one.

• Click the date or NA to display the Pre-Surgical Screening Case Management page.

• Green fill colour indicates the patient is prepared.

• Yellow fill colour indicates the patient is in progress to being prepared.  

• Red fill colour indicates the patient is not prepared.

Clipboard column

The Clipboard column is used so you can identify specific patient cases that you have dealt with or want to deal with. Once added to the Clipboard, you can filter on the “clipped” status to display that subset of cases. For example, you want to print the booking forms for specific patients. Because you need to check each case prior to printing, you want to make note of which ones you have processed. Use the Clipboard column by selecting the checkbox to select cases as a reminder that you have dealt with it. Alternatively, you want to do a bulk printing of the booking forms for that specific set of patients. Use the filter to display only the ‘clipped’ patients and then print all booking forms.

When you return to complete your task, even if it is the next day, the checkmarks remain.

Use the List Filters to include or exclude the patient cases with the selected checkbox from the list to narrow your list.

OR column

• Click the Print booking form icon in this column to view and optionally print or download the booking form for the patient.

Name

• The patient’s name.

• Click the patient’s name to open Pre-Surgical Screening Case Management page.

MRN

• The patient’s hospital identification number.

Age

• The patient’s age calculated as of today.

Procedure

• The procedure or procedures.

Pri

• The priority assigned to the case.

Provider

• The provider performing the surgical procedure.

Care Venue

• The care venue where the procedure will be performed.

Comorb/Alerts

• Identifies with a red Y if the patient has any comorbidities or alerts.

• Click the red Y to view the patient’s comorbidities, alerts, relevant medications.

Current Surg Date

• The current surgical date assigned to the patient’s case.

View List Actions

View Booking Forms

Use this action when you want to view and optionally print or download the booking forms for the patients listed in View List.

View Attachment Forms

Use this action to view and optionally print or download the attachments for the patients listed in View List. All the attachments are displayed sequentially in the dialog.

View List Filter

View list displays information about the patient requiring optimization. Each list can be subsequently filtered on a variety of criteria such as provider service, ASA class, and number of cancellations associated with the cases. Note: the filters available may vary from what is shown below depending on your site’s configurations. For example, you may not have ASA Class.

• For filters PSS Status, Anesth, Cancellations, Comorbidities, Clipped, Attend Short, Patient Alerts, Relevant Medications, Schedule Appointment Type, IP/OP, Preop Appointment Status, ASA Class, select a criterion from the list.

• For filters Care Venue, Attachments, Service, you can select one or multiple values. Use SHIFT+click or CTRL+click (CMD+click) to select multiple items.

• For filters Surgery Date and Provider, click Yes and then click Show.

• For Surgery Date, choose one of the options and either a predefined date range or a custom date range.

• For Provider, choose one or more of the providers.

• Click Apply Filter to filter the View List using the selected filter criteria.

• Click Reset All to clear all the filters from View List.

Pre-Surgical Screening Case Management

The Pre-Surgical Screening Case Management page displays the patient’s case and allows you to document and manage details about the case. Any changes you make, for example adding another preoperative requirement, scheduling a preoperative activity, or marking the patient as prepared, are immediately reflected in the provider’s office and a secure message is transmitted. Conversely, any changes the provider’s office may make to a patient’s PSS requirements and outcomes, are immediately reflected here. (Please read the Novari ATC Getting Started and User Preferences User Guide to learn more about messaging).

To open the Pre-Surgical Screening Case Management page, do one of the following:

• From View List, click a patient’s name.

• From Preops Requirement List, click a patient’s name.

• From PSS Notifications, click a patient’s name.

• From the Patients List in Appointment Booking, click a patient’s name.

Patient Preparedness Status

The patient’s current state of preparedness is displayed at the top of the Pre-Surgical Screening Case Management page.

Preparations & Alerts

This area displays the preparations and alerts that may have been added during the Add Patient process, or subsequent edits to the patient case using View Patient.

Note: Your list of Preparations & Alerts may differ from what is shown below because of your unique configuration requirements.

Preparations & Alerts area of the Pre-Surgical Screening Case Management page. Your area may be different from what is shown.

To modify a preparation or alert:

• Click ASA Class to open the ASA Class dialog to change the patient’s ASA class.

• Click Comorbidities to open the Comorbidity Alert dialog to view or edit the comorbidities.

• Click Patient Alerts to open the Patient Alerts dialog to view or edit the patient alerts.

• Click Medication to open the Medical Alerts dialog to view or edit the medications.

• Click Attachments to open the Document Attachment dialog to scan or upload a document. For information on scanning or uploading Attachments, please read Novari ATC Provider’s Office User Guide.

• Click Edit to edit the attachment document type.

• Click Deactivate to deactivate the attachment. Show deactivated attachments to see them.

Click Reactivate to reactivate them.

Attachments

The Novari ATC Attachments functionality allows you to digitally attach documents to a Novari ATC case record. The main purpose of Attachments is to reduce paper-based transmission of documents to other parties such as the provider’s office and the OR. Any document can be attached electronically, but you should talk to your Novari ATC administrator to determine which attachments are appropriate for your installation.

Attachments can be associated with the case record in one of two ways – they can be scanned directly using a document scanner, or they can be attached directly in a supported format. For more information regarding scanner compatibility contact your Novari ATC administrator.  

There is a listing of all existing attachments for the case on the Pre-Surgical Screening Case Management page. These attachments can be added by any user with access to the case – in the Provider’s Office, Pre-Surgical Screening, or Care Venue. Click the attachment description to review an individual attachment.

To attach a digital document or image to a case record, do one of the following with a patient’s case open in Pre-Surgical Screening Case Management:

• Click the Paperclip “Plus” icon beside the patient’s name.

• Click Attachments in Preparations & Alerts.

Existing attachments as they appear on the PSS Case Management screen.

Your Novari ATC administrator may have set attachment document types to be associated with Preoperative

Requirements/PSS activities. For example, the document type, Blood work, can be associated with the Preoperative Activity RN Review. When RN Review preoperative activity is added to the patient’s case, the Attachment paperclip icon appears and, when clicked, opens the Blood work attachment.  

How it works:

• The attachment document type is associated with a preoperative requirement and/or a preoperative activity by the Novari ATC administrator.

• If the document has been attached to the patient’s case and been assigned the document type, when the preoperative activity or preoperative requirement is added to the case, then the Attachment paperclip icon appears in the requirement or activity.

• When the preoperative requirement or preoperative activity has been added to the patient’s case, but the document has not been attached to the patient’s case, when the document is attached and is assigned to the document type, then the Attachment paperclip icon appears in the requirement or activity.

Procedural Information

This is a summary of the patient’s procedural information. You can view/print the OR Booking Form. Any changes to the detail information must be done in View Patient.

Preoperative Requirements and PSS Preoperative Activities

This section displays the preoperative requirements and preoperative activities that need to be completed for the patient deemed to be prepared.

As a Pre-Surgical Screening user, you manage the preoperative requirements and activities.  

There are two sections: one for preoperative requirements and the other for PSS preoperative activities.

For this patient, only PSS staff can mark results received and manage the Completed status.

Icon Legend

Date of Requirement

You can optionally edit dates assigned to requirements if a requirement or activity has an optional or mandatory date. Some requirements and activities may not display a date field.

To add or edit a date, do one of the following:

• Click in the date field and enter a date using the format displayed.

• Click the calendar icon, navigate to the desired month, and click the day.

Activities may have appointment dates if the Preoperative Activity was defined as being schedulable by your Novari ATC administrator. As a Provider’s Office user, you may have permission to schedule a preoperative activity appointment date.

Results Received and Completed

Your ability to indicate that results have been received and to change the Completed status is controlled by the PSS venue configuration. Permission to mark results received and manage the Completed status can be granted to PSS, Provider or both.

Results Expire

If a requirement has an expiration associated with it, the date will be displayed once the Date of Requirement is entered. Novari ATC automatically resets the status of a case should results expire. Requirements and activities may have expiry dates. For example, blood work results may expire after 180 days. These expiries are specified by your Novari ATC site administrator.  

The Blood Glucose (On Admission) expires in 180 days. When the date of requirement is entered, the results expiry date is calculated.

View History

You can view a patient’s history from the Pre-Surgical Screening Case Management page.  

To view a patient’s history:

• Click View History from the top or the bottom of the patient’s case.

Navigation

You can navigate to the previous or the next patient’s case that needs to be reviewed by clicking Previous or Next.

Overrides

You may, from time to time, decide to override a patient’s readiness to prepared even though there may be incomplete requirements or activities.  

To override a patient’s readiness in Pre-Surgical Screening Case Management:

• Click Override.

Override Patient Status dialog

The Pre-Surgical Screening Case Management status indicating the patient’s status has been overridden.

The stylized O icon indicates this patient’s readiness has been overridden To cancel the override in Pre-Surgical Screening Case Management:

• Click Undo Override

Overridden Patient Statuses are displayed in Provider’s Office when viewing a patient in PSS, Care Venue Day View,

Care Venue Day View

PSS Notifications

PSS Notifications page informs you of changes to patient cases (removals and booking changes), appointments scheduled outside of the appointment window, and appointments that need to be scheduled.

The screen shows a summary of the case removals, booking changes, appointments outside of their booking window and unscheduled appointments. The user can clear the case removals and booking changes and reschedule/schedule the appointment window notifications and unscheduled appointments from this screen.

Case Removals

Any patient listed under this heading has been completely removed from Novari ATC for whatever applicable reason by the Provider’s Office. For example, the patient no longer requires surgery, or the patient died.  

Follow your internal procedures for any actions that may need to be taken concerning patient charts, for example, when cases are removed. Once appropriate action has been completed, select Clear for that patient.  

Booking Changes

Displays patients with changes to their surgery date.

Follow your internal procedures for any actions that may need to be taken concerning patient charts, for example, when cases are rescheduled. Once appropriate action has been completed, select Clear for that patient.  

Appointment Window Notifications

Displays patients with a preoperative activity that is outside the scheduling window. Change the appointment date or click Ignore to accept the appointment date that is outside the scheduling window.  

Unscheduled Appointments

Displays a list of preoperative activities that need to be scheduled. Click the calendar icon to schedule that patient’s activities.

Preoperative Requiement List

The Preoperative Requirement List displays the outstanding preoperative requirements for all cases submitted to Pre-Surgical Screening. You can add or edit dates assigned to a requirement, indicate when results have been received, and change the Completed status.

To display the Preoperative Requirement List:

• Select Preop Requirement List from PSS in the Pre-Surgical Screening navigation menu.

• Optionally, choose to show pooled patients.

• Overdue preoperative requirements are highlighted with red.

You can optionally filter the list of requirements to focus on specific requirements, services, providers, patient, or surgery dates.

Scheduling Appointments

Appointment Calendar

Your appointment calendar is your main working area for managing forthcoming appointments. It opens with a view of the current month’s appointment blocks for each day and allows you to drill down to individual patient cases. From here, you can navigate to the Pre-Surgical Screening Appointment Booking page where you can schedule and reschedule patient appointments.

To open the Appointment Calendar,

• Select Appointment Calendar from PSS in the Pre-Surgical Screening navigation menu.

Change the Calendar View

By default, the Appointment Calendar opens displaying the current month. You can navigate to any month by doing any of the following,

• Click the single chevron > to navigate to the next month.

• Click the single chevron < to navigate to the previous month.

• Click the double chevron >> to navigate to the same month next year.

• Click the double chevron << to navigate to the same month last year.

• Click the month to navigate to any month in the current year.

• Click To Today to return to the current month.

You can view the calendar by ability to book or by readiness. Select the Settings icon in the top left corner of the Appointment Calendar.  

Ability to book, shown below, indicates which appointment types are available on each day. For example,

Optimizations can be scheduled on Mondays, Tuesdays and Wednesdays but not Thursdays or Fridays

Readiness indicates the number and status of patients with appointments on that day.

• Red – patient in not prepared

• Yellow – patient is in process of being prepared

• Green – patient is prepared although may have an outstanding appointment. This may occur when PSS staff have overridden a patient’s preparedness status.

You can filter the appointment calendar by all blocks, a specific block, all appointment types or a specific appointment type by using the filters at the top right.

Working with a Day

Each day displays the appointment blocks available for that day, or the readiness of patients with appointments booked that day, depending on which setting you choose from the appointment calendar settings.

Click the day Actions to display the list of available actions. Not all actions are available for each day. For example, if there are no attachments, the Print All Attachments action is not listed.

Track Activity

Select this action to open the day’s appointments in PSS Activity Tracking. Here you mark the appointment outcome and, when necessary, reschedule the appointment.

Click Lock to lock this appointment outcome. Only you can unlock it. Other PSS users see the locked appointment highlighted in red and the name of the person who locked it.

Print All Attachments

Select this action to display all the attachments for the day’s appointments. It is displayed in a browser tab and can be downloaded or printed.

Print Patients

Select this action to display the appointment schedule for the day. It is displayed in a browser tab and can be downloaded or printed.

Click the “+” sign beside the appointment block name to expand the block to show the different types of appointments the block has.

The coloured square beside the appointment block indicates the availability for each appointment type:

• Green - There are free appointments  

• Yellow - There aren't any free appointments but if you switch some appointments around, you could book another appointment. For example, if you leave two 30 minute slots open on the block, it will switch to yellow because you could potentially book another 60 minute appointment (this is dependent on the duration of the appointment type).  

• Red - The block is full, and this includes the overbooking time.

Click PSS beside the appointment block name or an appointment type to display the Pre-Surgical Screening Patients List filtered for those appointment types for the day. Notice the appointment block and appointment type filters are listed at the top of the Patients List.

From the filtered Patients List, click a patient’s name to manage the patient in Pre-Surgical Screening Case Management.

Click the day number to open the Appointment Booking page for that day.

Appointment Booking

Appointment Booking is displayed when you click on the day number for any day in the Appointment Calendar.

The appointment book opens for the default PSS venue as specified in your User Preferences. If there is more than one PSS venue, you can select another one form the PSS venue list.  

There are two parts of the appointment booking page: on the left is a list of patients who need an appointment scheduled; on the right is the day’s appointment books.

Appointment Book

The appointment book will vary depending on how many appointment blocks are available that day, the number of slots per block and the appointment types that can be booked in the bloc.  

Notice the appointment intervals for Open Appointments is 5 minutes whereas for Telephone Appointments it is 15 minutes.

You can hide and display the list of patients:

• Click the left arrow to hide the list of patients.  

• Click the right arrow to display the list of patients.

PSS List

Click PSS List to display the patients scheduled for the day in Patients List, filtered by the appointment block. Note: the number of appointments may not match the number of patients because a patient may have more than one appointment that day.

Block Filters

If you have many blocks in the same day, you can simplify the appointment book by using the Block Filter. You can show all or only one of the blocks.

For example, your day has six blocks. This morning you want to focus on ANA Consults, so you choose to display only that block.

To apply a filter to a block:

The calendar on the left displays all blocks. The calendar of the right is filtered to show only the ANA Consult block.

Overbooking

You may be able to overbook appointments in an appointment block for a given day. This depends on the appointment block’s settings and by enabling overbooking by selecting that option in Block Filter.

For example, the Optimization appointment block was configured to allow 1 overbooking slot, 1 overbooking in that slot and maximum of 60 minutes overbooking. When overbooking is enabled, the Overbooking slot appears. You can schedule an appointment in the Overbooking slot until you reach the maximum overbooking time limit.

To enable overbooking for a block that allows overbooking:

• Select Overbook from the Block Filter.

When you attempt to book more than allowed in the Overbook slot, a message is displayed informing you of the overbooking limits for that block.

Resources

Click the Resources link for an appointment block to see the list of appointment resources needed for that block.

List of Patients

This is the list of patients who have one or more preoperative activities that need to be scheduled. The list can include patients who have been sent to Pre-Surgical Screening and those who have not yet been sent. You can sort the list by patient name, procedure, surgery date, appointment type, acronym, or duration.

By default, the list shows only patients who need appointments booked. You can change the filter to show all patients with preoperative activities, whether they are booked or not, or only patients who have booked appointments.

The list of patients automatically filters itself to present only those appointment types that match that day’s appointment block appointment types. For example, if Wednesday’s appointment block is only for BNDL and RNRVW appointment types, only the patients with those preoperative activities will be displayed. This saves you trying to schedule a patient on a day that does not have the correct appointment type for the preoperative activity.

To search for a patient or change the list filter:

• Click Patient Search.

• To show only the patients who have not yet been sent to Pre-Surgical Screening, select Search Unsent and click Search.  

• To show only patients who can be booked within the application type appointment window, select Show Only Within Appointments Window and click Search.

• If you do not enter a patient’s name, MRN or HCN, the search returns all patients that match the filter criteria.

• To search for a patient, enter one or more of the following: first name, last name, MRN, HCN and click Search.

Manually Booking an Appointment

You can manually schedule appointments. The Appointment Book helps you find available appointment times.

To schedule a patient’s appointment:

• Navigate to the day where you want to book the appointment.

• Click the patient in the list of patients. The patient is highlighted in yellow.

• In the appointment book,  

• For all appointments where the patient can be booked, Book is enabled.

• For all appointments where the patient cannot be booked, Book is disabled.

• Click the enabled Book for the time and slot where you want to book the patient’s appointment.

• If the selected appointment time is outside the Appointment Types recommended timeframe, you will be prompted to confirm the booking or cancel the scheduling of the appointment.

View the Patient in Pre-Surgical Screening Case Management You can view the patient in Pre-Surgical Screening Case Management.

To view a patient:

• Click the patient’s name in the scheduled appointment.

• Select View Patient.

Cancelling an Appointment To cancel an appointment:

• Click the patient’s name in the scheduled appointment.

• Select Cancel Booking and confirm the cancellation.

PSS Mini Scheduler

The PSS Mini Scheduler allows you to schedule any outstanding required PSS appointments from a simple and single interface.  

You can open the Mini Scheduler by clicking the calendar icon in:

• View List.

• Care Management.

• PSS Notification page.

Activities that have yet to be scheduled may appear with recommended appointment times, or when recommendations can’t be made, the appointment can be scheduled manually.  

When you choose to Schedule Manually, you are presented with the scheduling dialog. In the example below, you are informed of the scheduling window for the appointment type, the surgery date, and a calendar from which to select the appointment date.  

Select the contact telephone number.

When you select a date, you are presented with the appointment block for the day.

Click Book to select that appointment time.

Optionally, if allowed by the appointment block settings, you can select Overbook to open the Overbook slot and book the appointment in that slot if none are available in the other slots.

Whenever you book an appointment, the Mini Scheduler dialog refreshes and displays the scheduling information. Select the contact telephone number.

Using Book First Available

Book first available can speed up the booking of appointments. Book First Available is only available when booking today as of the current time and future dates. It is not enabled when on a date in the past or when there are no available appointment slots remaining today as of the current time.

To book the first available appointment:

• Navigate to the day on which you wish to book appointments.

• Select a patient in the list of patients.

• Click Book First Available On [current date].

• You are informed of the first available date for the appointment.

• Click Confirm to book the appointment or Cancel to end the scheduling action.

Appointment Blocks

Your appointment blocks were probably initially created by your Novari ATC administrator; however, you may need to create new blocks or edit existing ones to suit the changing needs of your Pre-Surgical Screening workflows.

Appointment blocks represent a block of time on a certain recurring day dedicated for the appointment types chosen. Appointment blocks can be specified as “unavailable time” on a per day basis if the PSS user wishes to reserve that time for future use.  

When creating a new PSS Appointment Block, you will be prompted to provide the following information:

1. A descriptive label for the block which will make it easy to find later.

2. The number of slots, which is equivalent to the number of patients that can be booked concurrently. This is typically related to the number of rooms.

3. The number of cases greater than the number of slots which can be booked. This can be used for managing last minute patients. This is a mandatory field, and the value must be between 0 and 10 inclusive.

4. The maximum number of minutes the block can be overbooked. This is useful in proactively defending against the misuse of the overbook feature. This applies to the whole block.

5. A start and end time for the availability of the room. Note that this range must be divisible by the time length of the appointment type. (If there are many appointment types, it will be the greatest common divisor). Click in the date field to open the calendar.

6. How often this block repeats (in weeks) and on which days it will be available.

7. From which date the block will begin and on which date it will end.

8. The resources that will be available to the rooms. (Resources are managed by your Novari ATC administrator.)

9. The appointment types that are managed by this Appointment Block. (Appointment Types are managed by your Novari ATC administrator.)

To create a new appointment block:

• In Pre-Surgical Screening module, select Blocks from Appointments in the navigation menu.

• Select New block  

• Enter the required information as described above.

• Click Save.

When creating a new block, you can specify multiple days per week, many appointment types, appointment resources, and have it repeat for many months.

After you click Save in the Appointment Blocks – New Block dialog, the Appointment Blocks – Slot Availability calendar opens. This is a visual representation of your newly created appointment block.  

Use this calendar to block off timeslots so they are always unavailable for booking, for example for lunch breaks or other scheduled periods of unavailability.  

To block out a timeslot:

• Click once in the timeslot to make that period of time unavailable.

• Click Save.

The timeslot corresponds to the block activity. For example, if the activity type selected for the block has a duration of 15 minutes, then a 15-minute block is unavailable. If the activity type selected for the block has a duration of 60 minutes, then a 60-minute block of time is unavailable.  

Extending an Existing Appointment Block

After your PSS workflow has been up and running, some of your blocks may approach the end of their recurrence interval. If a block is worth preserving, you can choose to extend it.

To extend an existing appointment block:

• Select Blocks from Appointments in the Pre-Surgical Screening module navigation menu.

• On Pre-Surgical Appointment Blocks page, click the name of the appointment block you want to extend.

• In Appointment Blocks – Edit Block, click the end date to open the calendar.

• Select the new end date.

• Click Save.

EXTENDING A BLOCK WILL CAUSE THE UNAVAILABLE TIMESLOTS OF THE LAST DAY TO BE COPIED ONTO THE NEW DAYS. IF THIS IS NOT DESIRABLE, EXTEND THE BLOCK BY A SINGLE DAY AND

MAKE CHANGES TO THE AVAILABILITY OF TIME LOTS ON THAT DAY. ONCE YOU’VE DONE THIS, EXTENDING THE BLOCK TO THE DESIRED END DATE WILL RESULT IN THE PROPER UNAVAILABLE TIMESLOTS BEING REPEATED.  

Pre-Surgical Screening Status in Care Venue and Patient Registration Modules

The PSS module does not work independently of the other Novari ATC modules. When implemented, PSS patient status is communicated to the Provider’s Office, Care Venue and Patient Registration modules. This ensures that patients who require optimization are communicated to PSS staff well in advance of their planned surgery date.

Communication with the Care Venue Module

Care Venue scheduling staff can view a patient’s PSS activities and requirements if the patient has been sent to Care Venue.  

On Care Venue Day View, the number of cases sent to Pre-Surgical Screening is displayed. Red indicates the patient is not prepared. Yellow indicates the patient is in progress. Green indicates the patient is prepared.

The Care Venue Day View with the total number of cases for the day that have not been processed, are currently in progress or are prepared.

To view a patient’s pre-surgical screening status in detail, click Detail in PSS column.

Care Venue scheduling staff can also view this information on Care Venue Data Entry.

Communication with the Patient Registration Module

Uncleared PSS appointments (new or updated appointments for a selected patient) will appear in the “Uncleared Notifications” section (colour code grey, under Details Updated tab).  

This patient has five different Preoperative Requirements/Preoperative Activities which have been added or updated. These are easily recognizable by the rows of information being highlighted in red.