QI teams streamline perioperative practices
Cherished customs went by the wayside as people questioned the value of existing perioperative practices at the Palmetto Baptist Medical Center in Columbia, SC. Four QI teams met biweekly starting in late 1996. The degree of success on individual process changes correlated directly with how well the team members communicated with peers who were affected by the proposed changes.
Within months, the teams made dramatic gains in their aim to meet and exceed patient and physician expectations for value in quality and cost of the perioperative services.
Key practice changes resulting from the project include:
- Existing practice. A nurse left the operating room to read the chart and greet and roll in the next patient. "This could mean a 10-minute absence from the back where the nurse could assist with room preparations," explains Lynn Wythe, RN, MSN, nursing director of perioperative services. But the nurses enjoyed the patient contact, she adds.
- New practice. The anesthesiologist reads the chart and greets and rolls in next patient. The nurse assists with room change. On the way through the door, the anesthesiologist briefs the nurse.
- Results. Average room turnover time has decreased 11% (18 minutes to 16 minutes). Staffed utilization of operating room has increased 36%.
- Existing practice. Fewer than 5% of presurgical nurse-patient interviews were conducted by phone. Fewer than 50% of patients were preregistered prior to day of surgery.
- New practice. Twenty-eight percent of nurse-patient interviews and 98% of preregistrations are conducted by phone prior to the day of surgery.
- Results. Savings represent a half day of personal or corporate time. "I haven’t heard any complaints about long waits," Wythe notes. For in-person interviews of patients with cardiac conditions or comorbidities, the target wait is 15 minutes, actual average, 32 minutes. In a way, explains Wythe, the target is based on the Golden Rule: "[Staff] looked at our personal experience on doctor’s appointments. After 15 minutes in the waiting room, we start looking at our watches."
- Existing practice. On the day of surgery, patients routinely arrived at 6:30 a.m. hoping to beat the admitting department rush.
- New practice. Patients go directly to pre-op and complete everything there.
- Results. Pre-op unit hired and cross-trained extra nurse technicians to do EKGs in perioperative area instead of sending patients to another floor. Patients love the convenience and time savings.
For more on rapid-cycle change within perioperative services, contact: Lynn Wythe, Nursing Director of Perioperative Services, Palmetto Baptist Medical Center, Taylor at Marion Street, Columbia, SC 29220. Telephone: (803) 296-5309. E-mail: [email protected].
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