Case Study: Reducing Surgical Rescheduling from Weeks of Manual Review to Hours with Brim

The Challenge: Identifying High-Risk Surgical Patients Across Dozens of Criteria

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At a large academic pediatric health system, ensuring patient safety begins long before a child enters the operating room.

Within one pediatric ambulatory surgery center (ASC), some children scheduled for procedures at a low-acuity location are ultimately too high risk for that setting and must be rescheduled to a higher-acuity campus. Identifying these patients early is essential, but complex.

A centralized preoperative assessment clinic is responsible for this review. Nurses must evaluate hundreds of upcoming surgical cases each month, applying dozens of clinical inclusion and exclusion criteria spanning:

• Cardiac conditions
• Respiratory risk factors
• Neurologic and psychiatric considerations
• Endocrine disorders
• Hematologic conditions
• Genetic syndromes
• Implanted devices
• Procedure- and age-specific BMI thresholds

Much of this information lives deep inside unstructured clinical notes, scattered across consults, problem lists, and historical documentation.

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The Manual Process

Before Brim, this work was performed entirely by hand:

• Reviewing the next month’s surgical schedule
• Opening and reading every individual patient chart
• Searching for evidence that might disqualify a patient from surgery at the ASC
• Flagging high-risk cases for escalation and rescheduling

This process required ~320 nursing hours per month, even though only a small subset of patients ultimately required intervention.

The result was a workflow that was:

• Labor-intensive
• Difficult to scale
• Prone to fatigue and bottlenecks
• Costly in highly trained nursing time

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The Brim Approach: Automated Abstraction with Evidence-Backed Review

The preoperative assessment team partnered with Brim to re-imagine this workflow; not by replacing clinical judgment, but by dividing patients into those likely to be low-risk and those likely to be high-risk, and making it easier for nurses to review the information needed to make a decision.

Using Brim, the team configured structured abstraction logic to automatically identify high-risk indicators from each patient’s chart based on the clinical criteria nurses were already using.

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The New Process with Brim:

• Brim automatically abstracts high-risk indicators from patient charts
• Patients flagged as potentially high risk are surfaced for detailed review
• Each flagged criterion includes clear supporting text evidence
• Nurses focus their time on clinical decision-making, not information retrieval

Every scheduled patient is still reviewed by nurses, but they can focus their attention on reviewing the flags and making decisions, not on finding the underlying information in the chart.

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The Results: Massive Time Savings Without Sacrificing Accuracy

The impact of this change was immediate and measurable.

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Brim reduced the rescheduling review workload from ~80 hours per week to ~4 hours per month, while maintaining 99% agreement between Brim and nurse review across a four-month evaluation period.

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Why This Matters: Scaling Safety-Critical Workflows

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This case highlights a common challenge across healthcare operations:

• Critical decisions depend on information buried in clinical notes
• The work is repetitive but requires clinical expertise
• Manual review does not scale with increasing patient volume

By combining automated chart abstraction with transparent, evidence-linked outputs, Brim enables teams to:

• Uphold patient safety standards
• Reduce burnout among clinical staff
• Reallocate time to higher-value patient care
• Scale workflows without linear staffing increases

For this preoperative assessment clinic, Brim didn’t just save time; it fundamentally changed how surgical readiness is evaluated.

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Looking Ahead

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As health systems continue to manage increasing complexity with limited resources, workflows like this demonstrate what’s possible when AI is applied thoughtfully, transparently, and in partnership with clinical teams.

If your team is spending hours searching charts to answer structured clinical questions, Brim can help.

Interested in learning more? Contact us to see how Brim can support your workflow.