The Effect of Surgical Nurse Navigator Implementation on Urogynecologic Surgery Delays and Cancellations

INTRODUCTION: Many surgical clinics are attempting to streamline the patient experience between clinic visits and surgery. One strategy is the implementation of a surgical nurse navigator, but there is limited research on the role of surgical nurse navigators in preoperative optimization of patients. OBJECTIVE: To analyze whether implementation of a surgical nurse navigator affected urogynecologic surgery delays and cancellations at our institution. METHODS: This study was a retrospective chart review of 494 urogynecology patients at our institution. All patients for whom a surgical booking slip was placed by a urogynecology surgeon between 2/1/23–7/31/23 and 2/1/24–7/31/24 were included. These time periods represent surgeries scheduled pre- and post-implementation of a surgical nurse navigator. Data collected included demographics, surgery type, whether surgery was delayed or cancelled and the indication for delay/cancellation, whether the patient was referred to a primary care provider (PCP) for preoperative optimization, and whether there were any perioperative medical complications. Descriptive statistics are reported for groups with and without a surgical delay or cancellation. Outcomes included the association of nurse navigator with delay or cancellation of surgery, the time from scheduling to surgery, reasons for delay/cancellation, and perioperative complications. A binary logistic regression was performed, regressing surgery delay/cancellation on presence of a surgical nurse navigator. RESULTS: There were no significant demographic differences between patients who did not experience surgery delay or cancellation and those who did experience a delay or cancellation (Table 1). Patients with surgical delay had a median time to surgery of 178 days compared to 85 days without delay (p<0.001). We identified 229 patients scheduled for surgery before the implementation of a surgical nurse navigator compared to 265 patients scheduled following implementation of the nurse navigator (Table 2). There were no significant differences between pre- and post-navigator groups in time to surgery, number of delayed/canceled surgeries, or number of referrals to a PCP. Pre-navigator median days to the PCP visit was 59, compared to 89 days post-navigator (p=0.048)—although this is not clinically significant as it did not lead to significant surgical delays or cancellations. Prior to nurse navigator implementation, 5 surgeries were delayed or canceled due to elevated A1c, compared to 0 canceled surgeries after implementation (p=0.021). There were no other significant differences in reason for delay or cancelation between groups, and there were no significant differences in perioperative medical complications. The logistic regression showed that patients who were scheduled after implementation of the nurse navigator had 0.81 times the odds of surgical delay or cancellation (95% CI, 0.54, 1.21). CONCLUSIONS: We found that in our practice, the implementation of a surgical nurse navigator into urogynecologic surgery scheduling did not have a statistically significant impact on surgery delays or cancellations. Importantly, the nurse navigator may have other benefits that we did not study, such as patient satisfaction. Future research should be conducted to further explore which elements of urogynecologic surgery are impacted by surgical nurse navigators and how to reduce surgical delays and cancellations.Table 1Table 2