Abstract

NM-345

Improving Efficiency for Pediatric Anesthesia Cases in a Tertiary Care Free-Standing Children's Hospital: An Analysis of First Case on Time Starts

Darling A, Sawardekar A, Suresh S, Sohn L, Jagannathan N
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United states

Introduction:

Surgical and procedural services are high cost operational services. Improvements in first case on-time starts can impact subsequent delays, OR capacity, missed revenue, patient and staff satisfaction, and management of surgeon block times. The percent of on-time first case starts at Lurie Children’s Hospital (LCH) ranged from 62-66% over the last 5 years. Our goal was to improve on-time first case starts by 10 percent, to 76%, in 6 months.

Methods:

A multidisciplinary team was established including anesthesiologists, surgeons, and nurses. Causes of delay were collected over 18 months. Factors with the highest potential impact were identified. After process improvements were implemented, data collection and analysis continued for six months.

Results:

Three main causes identified were: surgeon related, patient/family related, or other (pre-operative coordination/assessment, anesthesia, OR setup/staff, and laboratory draws, etc.). Action plans were considered separately by category.

An action plan to address surgeon-related delay has not yet been implemented; however, during our initial time period surgeon-related delay was decreased by 25%.

Two main patient and family causes were addressed: 1. Delayed patient arrival, and 2. Delayed check-in process. Pre-surgical information booklet and pre-screener messaging were revised to include navigation guidance, timelines, expected travel challenges, and wayfinding once at LCH. Point of service staffing hours were expanded and “float” staff were added. After implementation, patient related delays decreased by 33.3%.

In the pre-operative area, nursing assignments and patients for a given service were spread out across the unit, leading to excessive travel between patients, and inability to maintain visual on patients, rooms, and staff. Patient complexity was also not factored into RN assignments. A care “pod” system of 4 RNs was established. Specific RN tasks were identified to allow for better support within their pods. Medically complex patients were flagged the night before and divided between the pods. Patients for a particular service were also grouped geographically. After implementation, OR delays secondary to preoperative assessments decreased by 59.1%.

At the end of the 6 month trial period, first case on-time starts were improved from 61% to 74%.

Discussion:

Several factors contribute to first case start delays. By identifying major causes for delays, we were able implement successful action plans and decrease patient-related, preoperative assessment, and coordination related delays. During our initial time period, we have seen an improvement in first case on-time starts from 61% to 74%. We plan to continue to address other areas of delays (surgeon related, anesthesia related, OR staff related) and evaluate OR efficiency, patient and provider satisfaction, and reducing missed OR revenue.