Name: ________________________________________
Date: _________________________________________
Procedure 9-4:
Scheduling an Inpatient Surgical Procedure
Objective: Schedule an inpatient surgical procedure.
Equipment and Supplies: Patient’s chart; patient’s insurance card; notepad and pen; written
instructions for patient (if required)
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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1. Review the patient’s chart for
the most current information.
Make sure the chart contains
the physician’s notes and orders
regarding the surgical procedure.
2. Verify with the physician the type
of procedure for which you are to
schedule the patient, and gather
the following information from the
physician:
• Categorythesurgicalprocedure
falls under (routine, elective,
urgent)
• Nameofthesurgeontoperform
the procedure
• Thesurgeon’sscheduling
preference for this type of
procedure
• Estimatedlengthoftimeforthe
procedure
• Estimatedlengthofstay
3. Gather the following information
from the patient and patient’s chart:
• Patient’sfullname,age,
sex, and any other pertinent
identification or information
• Physician’scurrentdiagnosis
• Anyallergies
• Specialpreoperativeordersand
patient instructions
• Patient’sinsuranceinformation
Name: ________________________________________
Date: _________________________________________
POINTVALUE
= 3–6 points
= 7–9 points
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4. Obtain preauthorization from the
patient’s insurance company, if
required.
5. Contact the surgery scheduler at
the facility and relay the requested
surgery information. The surgery
scheduler is the person in
the hospital or surgery center
who schedules the procedure,
including the necessary
preoperative appointments (e.g.,
blood work, chest X-ray, etc.), the
actual surgery, and postoperative
appointments, if necessary.
6. The surgery scheduler will confirm
the date and time of surgery and
any special instructions to be
relayed to the patient.
7. Record the surgery scheduling
information in the patient’s chart.
8. Record the surgery information
on the appropriate physician’s
schedule.
9. Follow oce procedure and the
surgeon’s request for contacting
other members of the surgical team.
Name: ________________________________________
Date: _________________________________________
POINTVALUE
= 3–6 points
= 7–9 points
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10. Instruct the patient on special
preparation and admission
procedures. Provide written
instructions, if available.
GRADING
PointsEarned
Points Possible 69 69
PercentGrade(PointsEarned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
Name: ________________________________________
Date: _________________________________________
POINTVALUE
= 3–6 points
= 7–9 points
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