86 - Inpatient Pathway for Surgical Readiness: Preparing patients for surgery

Description:

Background:
Nurses in the pre-op holding area, called inpatient holding, noted that many patients were arriving from inpatient units to their department without the necessary pre-procedure tasks completed. These tasks included drawing blood work including type and screens, removing dentures, glasses and other belongings, ensuring intravenous access, completing pregnancy tests, administering pre-op medications, administering ordered antibiotics, completing consents, and sending family to sign consents if patient unable. When patients are not adequately prepared for surgery, there are actual or potential delays in nursing care, delays in operating room start times, RN and provider frustration, and strain on resources. In addition, not completing tasks and not completing them in a timely fashion could negatively influence patient outcomes. The pre-op holding nursing staff then must work swiftly to complete pre-op tasks that should have been completed sooner. The PACU LEAN team developed an intervention plan to address this issue to ultimately improve the efficiency and overall image of the perioperative department.

Methods
Using audit forms for staff to fill out for any patient arriving to the pre-op holding area, the nurses on the PACU LEAN team gathered data over several months identifying when tasks were completed or not completed prior to arrival to their department. The team compiled this data and once reviewed applied interventions to improve the process. These interventions included individual education and partnerships with some inpatient units with increased surgical patient census and a mandatory education training on the online learning platform for all nursing staff. The team then collected data again using an updated audit form for any patient arriving to the inpatient unit and compiled data a second time.

Findings
The data collection showed that every inpatient unit in the hospital continued to have instances of inadequate task completion, revealing a significant lack of education on preparing a patient for surgery. In March of 2025, out of 384 surgical patients the team found that there was only a 2.34% compliance rate of pre-procedure task completion. The team worked with other entities to create job aids, a single point lesson, and badge buddies to assist in increasing knowledge of nurses from inpatient units. In addition, they created a pull system for receiving patients to the pre-op holding area and trialed it with two of the inpatient units.

Conclusion
The standard of care for preparing a patient for surgery should be met 100% of the time. Nursing staff at this hospital have been given information, education, and training in various capacities on how to do so. These trainings will help improve knowledge of the inpatient nurses so that patients will arrive to the inpatient holding area prepared for a surgery. By accomplishing this, the necessary tasks will be completed timely and safely which will optimize patient outcomes as well as improve efficiency of the perioperative department.