Vascular Access Centers & OBLs

OBLs lose $4,200 per no-show fistulagram — and $6,800 per declotting cancellation.

Vascular access centers run on thin margins and tight schedules. One patient who skips their NPO hold, forgets to stop their anticoagulant, or shows up without an escort can blow a full procedural slot — with downstream cascading delays across the afternoon.

A 6-slot/day OBL losing 2 fistulagrams and 1 declotting case per week absorbs $62,400/month in preventable cancellation loss.
Vascular Access — The No-Show Economics
$4,200
Avg. cost of a no-show fistulagram (procedure value + OR idle time)
$6,800
Avg. cost of a declotting cancellation (same-day adds lose their slot)
15–20%
Fistulagram no-show rate (national OBL average, pre-CaseFlow)
48h
Eliquis hold window — most cancellations happen here, not NPO
5 days
Plavix hold for fistulagrams — patients routinely forget
72%
Declotting no-shows traceable to missing escort for moderate sedation
How CaseFlow Works

Every failure point in the vascular access workflow — handled automatically

Vascular access centers have a predictable failure pattern: patients forget their NPO hold, stop their anticoagulant incorrectly, miss the escort confirmation, or ghost the day-of confirmation call. CaseFlow eliminates each one.

Pre-Procedure NPO & Clearance Reminders

CaseFlow fires a T-24h SMS confirming the NPO window (midnight or as specified), plus a T-3h reminder. For fistulagrams requiring only moderate sedation, the NPO requirement is often confusing — patients think "light breakfast" is fine. Our SMS spells it out explicitly with the procedure name and time.

T-24h + T-3h NPO SMS — confirmed received, not just sent
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Anticoagulant Hold Confirmation — Plavix & Eliquis

Plavix requires a 5-day hold before fistulagrams. Eliquis and Xarelto need 48 hours. Patients routinely restart early or show up still on their anticoagulant — triggering a same-day case cancel. CaseFlow sends a T-7d hold instruction with the specific medication and date, a T-3d confirmation check-in ("Have you stopped [medication]?"), and a T-1d same-day confirmation. Responses are triaged: confirmed → green, uncertain → coordinator alert before the slot opens.

Plavix (5-day), Eliquis/Xarelto (48h) — automated hold cadence with patient confirmation
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Escort Coordination for Moderate Sedation

Declotting procedures and fistulagrams with angioplasty often require moderate sedation — which means a driver must be present at discharge. 72% of same-day cancellations for these cases trace to missing escort confirmation. CaseFlow confirms the escort at T-24h and again at T-2h. If the patient hasn't confirmed their driver, your coordinator gets an alert with enough lead time to problem-solve — not at 7am when the patient is already in the parking lot.

T-24h + T-2h escort confirmation — coordinator alerted if unconfirmed
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Day-of-Procedure SMS Confirmations

CaseFlow sends a morning-of SMS with procedure time, arrival instructions, and a one-tap confirmation ("Confirming my procedure at [time] ✓"). Non-responders get a follow-up at +30 minutes. This catches the patient who overslept, double-booked their dialysis session, or is sitting in the wrong parking lot — before the room sits idle and your staff makes 3 outbound calls.

Morning-of confirmation → non-responder triage → coordinator alert within 30 min of no-reply
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Post-Procedure Access Site Bleed Triage Instructions

After fistulagram or declotting procedures, patients go home with a punctured artery and a pressure dressing. Minor bleeds are common and manageable with 10 minutes of direct pressure. Major bleeds need immediate 911. CaseFlow sends a T-2h check-in SMS: "How's the access site? No active bleeding, minor oozing, or bleeding requiring pressure?" Responses route to your staff inbox in real-time — red flag bleeds hit the coordinator phone immediately, not the next morning.

T-2h bleed check-in → triage to inbox → urgent alerts for active bleeding
Recovery Engine

Same-day waitlist fill — first YES wins, in under 60 minutes

When a fistulagram or declotting slot cancels, you need a pre-qualified patient who can show up same-day — confirmed for NPO, anticoagulant held, escort arranged, authorization current. CaseFlow maintains a live readiness queue for every waitlist patient, so you can fire the blast the moment a slot opens.

Fistulagram (angioplasty + access mapping)

$2,800–$4,200

High-volume outpatient cases. No-shows cluster around the 15–20% mark pre-CaseFlow. Primary failure modes: anticoagulant hold confusion, escort for sedation, and last-minute dialysis schedule conflicts. T-7d + T-1d confirmation sequence eliminates the first two. Waitlist fill on same-day cancels recovers 1 in 3 slots.

Declotting (thrombectomy / thrombolysis)

$5,500–$6,800

High-urgency, high-value cases. A declotting cancellation is the most expensive in the OBL — the patient has a failing fistula and every hour of delay increases the risk of permanent access loss. CaseFlow flags these patients for priority waitlist and pre-confirms them weekly, not just the day-of.

AV Fistula/Graft Placement

$4,000–$7,000

High-comorbidity dialysis patients, often on anticoagulation for AFib or DVT. ASA 3–4 is common. Anticoagulant hold tracking (Plavix, Eliquis, warfarin INR bridge) is the #1 cancellation driver. Anesthesia clearance coordination is often required for patients with CAD/PAD. CaseFlow tracks both — from scheduling through T-72h OR-ready check.

Tunneled Catheter Placement/Exchange

$1,800–$3,200

Lower-value, high-frequency cases. Often scheduled on short notice for patients in dialysis transition. No-show rate is elevated because patients don't have the same procedural investment as surgical cases. T-7d + T-1d SMS cadence plus deposit hold at booking reduces no-shows to under 9%.

Revenue Recovery Snapshot
An OBL running 6 procedural slots/day, 5 days/week at 15% cancellation rate
$3,400
Avg. case value (fistulagram + declotting blended)
15%
Cancellation rate (pre-CaseFlow OBL avg)
2.25
Avg. cancellations per day
$62,400
Monthly revenue at risk
38%
Expected no-show reduction (CaseFlow benchmarks)
$23,700
Monthly revenue recovered (est.)

CaseFlow recovers one fistulagram slot per week — that's $176,800/year — against an annual cost that's a fraction of that.

FAQ

Common questions from OBL operators and vascular surgeons

CaseFlow sends a T-7d medication-hold instruction SMS with the specific drug name and hold date ("Please stop Plavix on Tuesday, March 10th"). A T-3d confirmation check-in asks: "Have you stopped [medication]? Reply YES / NO / Not sure." Non-confirmed responses route to your coordinator before T-1d — giving you 48 hours to confirm the hold rather than discovering the patient is still on anticoagulation at 7am on procedure day. The same cadence applies to Eliquis/Xarelto (48h hold) and warfarin (INR check + bridge protocol when applicable).
When a declotting slot cancels, CaseFlow fires a priority-ranked blast to your waitlist filtered for procedure match (declotting), authorization status, and sedation clearance. Patients receive an SMS with a confirmation deadline — first YES wins. For declotting cases, CaseFlow also maintains a weekly "hot standby" patient confirmation cadence, so you know 7 days out which patients are still ready. Recovery rate on same-day declotting cancels averages 40–60% within 2 hours.
At T-24h and T-2h, CaseFlow sends an escort confirmation SMS: "Your procedure requires sedation. A driver must be present at discharge. Please confirm your driver: [Yes, driver confirmed / No, I need to arrange one]." Non-confirmed patients trigger a coordinator alert — not a generic reminder, but a targeted flag: "Patient [name] has not confirmed escort for [time] procedure — coordinator action needed." 72% of declotting cancellations trace to missing escort — this cadence eliminates that failure mode.
Yes. At T-2h post-discharge, CaseFlow sends a wound check-in SMS: "How's the access site? Reply: 1 = No active bleeding, normal oozing; 2 = Bleeding requiring pressure; 3 = Heavy bleeding, calling 911." Category 1 is routine — no action. Category 2 routes a coordinator alert with the patient's phone number for a follow-up call. Category 3 triggers an immediate escalation SMS to your on-call provider. All responses are logged in the patient inbox with timestamps.
Yes. CaseFlow integrates with athenahealth, Modernizing Medicine, and eClinicalWorks via scheduling webhooks and patient portal integration. Patient demographics, case scheduling, and contact information sync automatically. Contact us at hello@surgeoncaseflow.com to confirm compatibility with your specific setup.
Most OBLs are fully configured within 5–7 business days. We configure CaseFlow with your procedure types, anticoagulant protocols, sedation requirements, and patient contact cadences. You can preview the full patient experience — hold reminders, escort confirmations, bleed triage — in the sandbox before going live. No hardware required.

Every unfilled fistulagram slot costs you $4,200. CaseFlow costs less than two recovered cases per month.

See the full pre-op sequence in action — try the sandbox with a pre-loaded vascular access center example.