Orthopedic Pre-Op Calls and the Week Before Surgery

Orthopedic pre-op calls get treated as a courtesy and funded as an afterthought, usually by one coordinator who knows everything and takes no vacation. Then a case falls off the board on a Tuesday morning because nobody confirmed a ride, and an operating room that costs more per hour than anything else in the practice sits empty.

Surgery coordination is the highest-value scheduling work an orthopedic practice does and the least systematized. A booked procedure represents a room, an anesthesia slot, implants ordered, staff assigned, and a patient who rearranged their life. It is the appointment with the most dependencies and the least tolerance for a surprise.

Almost all of those dependencies are administrative. Did the patient get the instructions. Did they understand what time to arrive, which is rarely the time on the paperwork. Do they have someone driving them. Did the authorization survive the reschedule. Is the paperwork signed.

None of that requires a licensed clinician, and all of it can sink the case. So the practical question is not whether to automate the pre-op call. It is which parts of it a person still has to own.

Nobody confirms the day itself

Most practices confirm the appointment and assume the rest.

When MGMA asked practice leaders what they would focus on for patient access in 2026, no-shows came in as the single largest area at 27%, ahead of online scheduling at 24%, phone access at 22%, and wait times at 21%. For an orthopedic practice, a no-show on a clinic visit is an annoyance. A no-show on a procedure block is a different order of loss, and the causes are usually mundane.

The pre-op call that works is specific rather than polite. Arrival time and where to physically go, which is often not the main entrance. Whether someone is driving them home and who that person is. What they should bring. What happens if they wake up unwell, meaning who they call, not what they should conclude.

Each of those has a yes or no answer that can be captured, and each one has a fallback if the answer is no. That is the whole design. A confirmation call that only asks whether the patient still plans to come has confirmed almost nothing.

Instructions that have to move when the date moves

Pre-procedure instructions are written by clinicians and they are keyed to the procedure type. One practice’s example: the patient has to be told to stop a medication a set number of days before the procedure date.

That creates a timing dependency most systems ignore. The instruction is not attached to the day it was sent. It is attached to a date arithmetic that runs backward from the procedure. Move the procedure and the instruction has to move with it, or the patient follows a schedule keyed to a date that no longer exists.

The automation’s job here is narrow and important. Deliver the practice’s instruction set, unaltered, keyed to the procedure type. Confirm the patient received it. Recalculate and resend when the date changes. Log all of it against the encounter so the surgical team can see what was sent and when.

What the automation must never do is interpret the instruction, adjust it, or answer a question about it. A patient asking whether their situation is an exception is asking a clinical question, and that call gets handed to clinical staff every time. The value is in making sure the right instruction reached the right patient on the right timeline, which is a delivery problem, and delivery problems are exactly what gets dropped when one coordinator is covering forty cases.

Booking a procedure has side effects

This is where orthopedic surgical scheduling stops resembling ordinary scheduling.

At one multi-site practice, booking a procedure at a particular clinic also requires sending a case to that clinic’s staff so the room gets cleared and set up for the day. The rule exists at that location and nowhere else. Booking is not one write. It is a write plus a location-specific side effect that lives in somebody’s head until it does not happen.

There are more of these than anyone expects. The department a procedure physically happens in is not always the department the patient is booked under, and only some departments carry the extra appointment-type mapping that resolves the right provider. Procedure blocks have hard cutoffs driven by room turnover rather than clinic hours, so the last bookable slot is well before the practice closes.

And the one that costs real money: rescheduling can silently break the link to an existing authorization. The new appointment is not automatically attached to the authorization the old one had. A practice that reschedules a case without re-linking has a procedure that will happen and a claim that will not survive.

Automation earns its place here by making the side effects deterministic. When this procedure is booked at this location, create the case. When a booked procedure moves, re-check the authorization link and flag it if it did not follow. These are rules, not judgments, and rules are what a person forgets at four thirty on a Friday.

The regulatory floor is not the operational bar

Ambulatory surgery centers operate under federal requirements covering patient admission, assessment, and discharge, which set out what has to happen around a surgical episode.

Worth being precise about what that means for this discussion. Those requirements govern clinical assessment performed by clinicians. They are not a checklist an automation works through, and nothing in a pre-op confirmation call satisfies any part of them.

What they do establish is that a surgical episode has a defined structure with steps that must occur in order and be documented. The administrative shadow of that structure is what the front office runs: making sure the patient arrives at the right place at the right time having done the right preparation, with paperwork complete and the escort arranged, so that the clinical steps can happen on schedule.

Keeping those two things separate in your own language is the discipline. The clinical requirements belong to clinicians. The logistics that let them be met on time belong to operations, and that is the part worth systematizing.

What a coordinator should be left holding

The goal is not a coordinator-free surgical schedule. It is a coordinator working on the cases that need a human.

After automation, the calls that should still reach that person are the ones with a real exception. The patient who says they have nobody to drive them. The patient who cannot be reached after the defined number of attempts, close enough to the date that the slot may need to be released. The authorization that did not follow a reschedule. The clinical question that came back on a confirmation call.

Everything else, the outbound attempt, the confirmation capture, the instruction delivery and redelivery, the case creation, the logging against the encounter, runs on its own and appears as a list rather than a task.

The measurable outcome is on the board rather than in the queue. Fewer same-week cancellations traceable to logistics, fewer late starts, and a coordinator whose week is spent on twelve genuine problems rather than a hundred and forty phone calls to find them.

Key Takeaways

Confirm the specifics, arrival time and location, escort, and what to bring, rather than whether the patient still intends to come.
Key pre-op instructions to the procedure date, and recalculate and resend automatically whenever the date moves.
Never let automation interpret or adjust a clinical instruction. Questions about it route to clinical staff.
Encode location-specific booking side effects, such as the case that tells a satellite clinic to prepare a room, as rules rather than habits.
Re-check the authorization link every time a booked procedure is rescheduled, because it does not follow on its own.
Leave the coordinator the exceptions: no escort, unreachable patients close to the date, broken authorizations, and clinical questions.

A surgical schedule that holds is mostly a paperwork and phone-call schedule that held first. Automate the calls, keep the judgment where it belongs, and the board stops surprising you on Tuesday mornings.

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