St. Paul’s Hospital initiated a LEAN project to improve efficiency in the surgical daycare and operating rooms. The goals were to improve access, patient flow, patient and provider satisfaction and communication. A team at St. Paul’s Hospital involving surgeons, anesthesia, surgical department head, surgical managers, clinical nurse leaders, surgical directors, decision support and a consultant worked to reduce delays and improve the experience of surgical daycare patients.
The surgical daycare area functions as both a pre-operative and post-operative monitoring area, which can cause delays depending on bed utilization. Lead by vascular surgeon Dr. John Reid, the team received project funding from SSC.
The team’s analysis identified that pre-operative capacity, post-operative capacity, operating room (OR) turnaround time and slating accuracy were all contributors to patient delays.
As a result, three main process design changes were undertaken to reduce waiting:
• Surgical daycare patient flow
• OR turnaround time reduction
• Slate accuracy
Waiting was reduced through the addition of a pre-operative lounge, a post-operative lounge, and policy changes. These changes decreased surgical daycare bed utilization by pre-operative patients and allowed post-operative patients to return to surgical daycare when they were ready.
The addition of the pre-operative lounge resulted in a statistically significant reduction in patient waiting in the Post Anesthetic Care Unit (PACU) upstream of surgical daycare, and improved the working environment for nurses by reducing congestion.
Dr. Reid noted, “Our St. Paul’s Hospital surgical team has learned from this experience, made positive changes and gained efficiencies.”
The creation of a tool to assess case time history when setting the slate improved accuracy and OR turnaround time was reduced through better communication regarding patient and process status to members of the surgical team.
The impact of the other changes is currently being measured; however early indications show capacity created by the addition of the post-operative lounge will reduce PACU bottlenecks. The next steps will be to maintain these changes, including funding the flow clinical nurse leader position so that reductions in waiting time are sustained.