114 - Periop QI: Aligning Staff and Patient Workflows Across Phases of Care

Description: This initiative aimed at improving workflows and patient outcomes in the outpatient procedure center (OPC) setting was led by a multidisciplinary team of Orthopedic surgeons, nursing, operations, and anesthesia leadership. The team included frontline staff from nursing, sterile processing, Orthopedic surgery, and Anesthesia.

The ADKAR framework was used for change. The need for change arose from rising surgical volumes and staff feedback on inefficiencies in perioperative workflows. Leadership recognized that fragmented communication, inconsistent implementation, and lack of frontline staff input reduced staff buy-in.

Staff were involved early through surveys and shared governance forums. Staff feedback revealed a desire to improve both the work environment and patient care processes. As input was visibly included in planning, enthusiasm for the initiative grew.

Education was delivered through team huddles, regular staff emails, and real-time coaching. Staff were trained on new or updated workflows as they were ready to be implemented. Best practices and literature reviews informed the initiative's design.

Implementation was phased to allow for practice and refinement. Staff received ongoing support and reinforcement in the new processes.
Regular check-ins and leadership rounding helped reinforce the changes. Spot checks and evaluations are periodically sent to evaluate ongoing successes or opportunities for reinforcement. Successes were celebrated, and data on improved throughput and satisfaction were shared to sustain engagement and momentum.

Preparation and Planning
The planning phase involved mapping current workflows, identifying bottlenecks, and aligning goals across disciplines. A shared vision for high-functioning OPC was developed, with clear metrics for success and a phased rollout strategy.

Assessment
Baseline assessments included staff surveys, workflow observations, and literature reviews. Key findings included variability communication gaps and signs of operational fatigue. These insights shaped the initiative's focus areas and interventions.

Implementation
Key interventions included:
- Standardized communication of surgical team needs during pre-op, intra-op, and post-op phases for nursing and anesthesia care
- Pre-operative pregnancy testing completed prior to surgery reducing day-of point of care (POC) testing
- Obtained additional storage space to accommodate expanding OR practices

Outcomes
- Reduce delay of on-time starts related to POC pregnancy testing
- Standardize communication amongst multidisciplinary teams to ensure each team has what they need
- Consistent teams and staff in OR

Implications for Perioperative Nursing
This initiative shows perioperative nurses driving system-level changes. By using the ADKAR model, nurses led care delivery improvements, promoted accountability, and showed the benefits of structured change management in clinical settings.