Quality Improvement Initiative: Streamline Inpatient Preoperative Anesthesia Assessment to Decrease Surgical Delays by Utilizing a Checklist
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Abstract
Introduction/Purpose: Delays and cancellations are detrimental to the operating room (OR) being efficient and cost-effective in the healthcare setting. Hospital systems must provide cost-effective healthcare to continue a healthy operating budget. The OR is a revenue generator for most hospital settings, however, if it is not managed efficiently, it can create large deficits. This concept is especially important in the OR given the many resources allocated to the department and the expense of running the department. Therefore, even the slightest of delays can be costly. There seems to be a multifactorial component supporting the underlying reasons for delays for inpatients scheduled for surgery. One area identified is the lack of a complete and thorough anesthesia preoperative assessment for inpatients resulting in day of surgery delays.
Methods: The Plan Do Study Act (PDSA) method was used for this Quality Improvement project. This method guided a plan to implement an inpatient preoperative checklist to decrease day-of-surgery delays related to anesthesia. Data from six weeks before and six weeks after an implementation in-service was collected and analyzed from Excel reports provided by the preoperative nurse manager.
Results: A Chi-square comparing pre-implementation of the inpatient preoperative checklist and post-implementation was performed to see if improvements were made in surgical delays on the day of surgery. Before the in-service (n=231), 178 had no delay and 53 had a delay (23%). After the in-service (n=442), 357 had no delay and 85 had a delay (19%). Although the Chi-square statistic was not statistically significant, X2 (1, N=673) = 1.2831, p = .257326, there was an improvement of on-time case starts from 77% preintervention to 81% post-intervention.
Discussion: Even though not statistically significant, the 4% improvement in on-time cases is clinically significant. The implications of the improvement can be seen in saving healthcare dollars, improving patient satisfaction by decreasing wait times, and improving efficiency in the perioperative unit.