Patient Selection for Elective Procedures

Susan Shepard, MSN, RN, Senior Director, Patient Safety and Risk Management Education

Many claims originate with patients who are not appropriate candidates for procedures. Having a well-planned and carefully executed patient selection process can help you identify patients who are good surgical candidates and those who may not be able to achieve satisfactory results.

Assess Prospective Patients

During the patient’s first visit, take time to ask questions and document the answers. The following questions can help you assess prospective patients:

  • Is this a repeat surgery or repair of another doctor’s work?
  • Has the patient sued another provider?
  • Is this a workers’ compensation case?
  • Does the patient’s spouse or significant other know about the procedure? If yes, does he or she agree with the decision for surgery? If no, why?
  • Is the patient financially able to handle the costs associated with the procedure and any additional procedures?
  • Does the patient have a history of compliance with post-op instructions?
  • During the past two weeks or in the two weeks prior to surgery, has or will the patient experience extended sedentary periods (e.g., long flights, bed rest, or car journeys)?

Warning Signs

Assess the patient’s body language and behavior for signs that may warrant additional assessment by the doctor or an advanced practice provider. Below are examples of warning signs:

  • Appears angry or hostile, has a sharp tone of voice, defensive body postures, or negative facial expressions.
  • Resents questions, makes defensive responses, or provides short or one-word answers.
  • Is demanding, self-centered, or lacks sensitivity to others.
  • Is overly complimentary of the doctor and office staff.
  • Has unrealistic expectations.
  • Blames another doctor for previous treatment.
  • Appears to be “doctor shopping.”
  • Has difficulty paying attention, is unfocused, interrupts, or changes the subject.

Informed Consent

Remember, questions asked during the patient selection process do not replace the informed consent process. Issues may surface during the informed consent process that indicate the patient is not a good candidate for the elective procedure.

  • Encourage patient participation through shared decision making. (See AHRQ: Shared Decisionmaking.)
  • Use the teach-back method to ensure patient comprehension. (See AHRQ: Teach-Back Method.)
  • Document the informed consent discussion, including the proposed treatment plan, potential risks, complications, benefits, alternatives, and the patient’s understanding and acceptance.

Staff Input

Many factors affect a surgical outcome. Office staff can contribute valuable information in the selection process. Listen when staff members voice “gut reactions” regarding a patient or a family member and allow them to contribute to discussions of denial of care.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J11757 11/18