139 - The Collaborative Approach to Improving Inpatient Flow to the Operating Room

Description: Description of Team: The project team included Operating Room Nurses (OR RNs), PeriAnesthesia Nurses, Clinical Nurse Specialists, Anesthesiologists, Surgeons, a QI Advisor, Data Analysts, a Parent Representative, and the Director of Mission Control.

Preparation and Planning: We identified inefficiencies in inpatient flow to the Operating Room (OR), with persistent inconsistencies in communication, handoffs, timing, ownership, and process initiation contributing to surgical case delays. These issues disrupted patient flow and negatively impacted both team dynamics and the patient experience within Perioperative Services. A lack of inpatient readiness was also a major contributor to OR delays and reduced throughput, highlighting the need for targeted interventions to streamline transitions and enhance preoperative efficiency.

Assessment: Data from Epic was analyzed using several key documentation benchmarks as patients moved through the perioperative process: Call for Patient, Patient Sent For, In PreOp, PreOp Tasks Complete, Anesthesia Start, and In OR. On average, it took 53 minutes from Call for Patient to PreOp Tasks Complete. Further breakdown showed:

Call for Patient to Patient Sent For: 24 minutes
- Patient Sent For to In PreOp: 19.4 minutes
- In PreOp to PreOp Tasks Complete: 10 minutes
- PreOp Tasks Complete to Anesthesia Start or In OR: 44 minutes
These findings pinpointed specific areas in the workflow for further investigation and guided the development of targeted interventions.

Implementation:
- Communication to Inpatient Nurse (Jan 2024): OR Coordinators and night shift Perianesthesia RNs used a standard script via call/EHR secure chat to notify inpatient nurses of surgery time and pre-op tasks needed.
- OR RN to PreOp RN Communication (Apr 2024): Standardized and posted the designated contact area and phone number for OR nurses to reach PreOp nurses when ready to send for an inpatient.
- Staff Education (Apr-Nov 2024): Disseminated emails and presentations to all OR staff. Provided in-services for Inpatient/Acute Care RNs on preparing patients for surgery/procedures.
- PreOp Nurse to OR Nurse Communication (Oct 2024): Implemented Epic Communication Status Board signal Call for next Inpatient. A color change on the Epic Status Board 60 minutes before current surgery end prompts PreOp RN to call OR RN to confirm readiness for the next inpatient.

Outcome: Data show improvements in almost all measured areas:
- Call for Patient to PreOp Tasks Complete improved by 17% (53 to 44 minutes)
- Call for Patient to Patient Sent For improved by 21% (24 to 18.9 minutes)
- Patient Sent For to In PreOp improved by 9.3% (19.4 to 17.6 minutes)
- In PreOp to PreOp Tasks Complete improved by 20% (10 to 8.2 minutes)
- PreOp Tasks Complete to Anesthesia Start or In OR (44 to 48 minutes)

Implications for Nursing: Nurses' expertise in preoperative readiness is essential for smooth OR transitions. Collaboration between inpatient and perioperative nurses optimizes patient readiness, streamlining the perioperative experience and improving surgical outcomes. Integrating nurses' insights and specialized knowledge into improvement initiatives is vital for enhancing OR efficiency.