152 - Improving OR First Case On-time Starts Using the EPIC Snapboard Shared Calendar System
Clinical Issue: On-time operating room (OR) first case surgical start times are important in maintaining on-time surgeries throughout the day. Increasing communication among OR and AOD nurses may help to improve first-case OR on-time starts. Description of Team: All authors on this poster are affiliated with the Houston Methodist Hospital System. Jennifer Rowland is a Registered Nurse; Danita Batiste is an OR Manager; Mona Cockerham is a Quality Specialist and Research Consultant. Preparation and Planning: To prepare for the on-time start assessments, an On-Time Start Tracker was developed to record key pre-operative elements: date, patient ID, scheduled start time, AOD time ready, surgeon arrival time, history and physical (H&P) completion time, OR nurse ready time, and time out of AOD (in minutes). Assessment: We assessed whether adding OR and AOD nurse assignments to an EPIC Snapboard Shared Calendar for daily morning assignments compared to a paper copy of the nurse assignment sheet, affected the number of minutes the first 10 OR case start times were delayed within a 7 week time frame.Implementation: Individualized training was provided to an OR charge nurse designee regarding use of the EPIC Snapboard Shared Calendar feature by inputting the names of OR and AOD nurses assigned to patients the morning of the assignments. Data were collected using the OR On-Time Start Tracker, which were pre-operative process items observed in AOD and recorded as on time, delayed (in minutes), or early (in minutes). If delayed, the reason for the delay was recorded in the tracker for each case. Outcome: Following the training, on-time first case starts increased by 30%, delays in first case starts decreased 23% , and test delays such as pre-operative x-rays (KUB) decreased by 7%. Average number of minutes for on-time first case starts increased by a difference of 1.03 minutes as compared to the average number of minutes for first case start delays which decreased by 15.02 minutes. Average number of minutes healthcare professionals had completed their pre-operative procedures prior to rolling out of AOD for first case starts increased by 4.33 minutes (OR nurses), increased by 12.55 minutes (Anesthesiologists), increased by 7.88 minutes (Surgeons), and increased by 4.9 minutes (AOD nurses). First-case start time delays were highest for surgeon delays (66%), test delays(14%), patient late arrivals (13%), H&P completion, (7%). Implications for Perioperative Nursing: Adding nurse assignments in EPIC SnapBoard is a helpful communication tool during the preoperative process to enhance communication between AOD and OR nurses and decrease first case on-time start delays.