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Achieving Better Prep, Execution, and Discharge in the OR
By Denice Soyring Higman
By Adam Higman
By Dragana Gough
http://www.soyringconsulting.com
Pre-Operative Phase
The OR should run like a well-oiled machine with patients moving through each stage seamlessly as the slightest factor can have lasting negative effects. As with most things, the process of improvement must start at the beginning with Pre-admission Preparation. Ensuring that patient files have an up-to-date History and Physical (H&P) and Laboratory and Radiology reports, as well as financial clearance will aid in the improvement process.
Some Vital Queries
One of the keys to improving preoperative performance is involving physicians. Assess where things stand by asking these questions:
- Is Anesthesia involved in team decision making?
- Are Medical Staff taking an active role in throughput?
- Is your Anesthesia staff reviewing patient charts for the next day?
- Anesthesia staff should assess a scheduled patient when the health history suggests potential problems
Holding Area or Not?
It depends. Most hospitals do not use holding areas for all patients, even though the areas may exist. Typical uses for holding areas include inpatient surgery patients and anesthesia services for line insertions, etc. For smoother transitions in the OR, you should consider elimination of multiple stops for outpatients.
Operative Phase
Operative throughput should start with an assessment of your instrument and supplies. This begins with a review of your case cart readiness, including the number of trays and instruments, used and unused. The goal of this review is to eliminate any additional unneeded instrument counting/processing. To avoid case delays, ensure that all materials and supplies pulled for the case are correct and your preference cards are updated. As with any procedure, make sure that the equipment is functioning correctly and that all personnel are fully trained for the job. Perform proper maintenance checks ahead of time and review storage and organization procedures to ensure that the equipment is readily available for the next case start time. Unreliable items that frequently break/malfunction can have a huge effect on turnover.
Team Approach to Operating Room Turnover
It is imperative that the OR staff be ready to start on time and every person in surgery should have a part of the turnover process. Surgeons can set the stage for expectations, especially if they are present during turnover/set-up. Do not let them perform a disappearing act. Work with surgeon’s office staff on scheduling issues if there continues to be a problem. For Anesthesia, Scrub, and Circulator staff, create buy-in for quick turnover time, utilize specialty teams, if possible, publicize turnover results (monthly), and celebrate improvements. Anesthesia can help transport patients from Holding/Day Surgery to OR and housekeeping needs to be readily available to assist with cleanup. Nursing staff can assist with cleanup of rooms and patient transport. The bottom line, everyone needs to pitch in whether it is in their “job description” or not.
Post-Operative Phase
To continue the momentum, make strides in post-op procedures starting with discharging from the post-anesthesia care unit (PACU). Acute care facilities should consider discharging select, low acuity patients directly from PACU.
Pre-Order Now
We are now preparing the next edition of our book: “Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies]. In-Process from: (c) Productivity Press 2012
http://www.crcpress.com/product/isbn/9781439879900
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Filed under: Experts Invited, iMBA, Inc., Quality Initiatives, Recommended Books, Research & Development | Tagged: Adam Higman, Denice Soyring Higman, Dragana Gough, Flow-Thru Logistics, http://www.soyringconsulting.com, Operating Room Efficiency | 7 Comments »
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