95 - Don’t Shrug It Off: Improving Efficiencies in Total Shoulder Surgery
Description: There is a constant demand to streamline surgeries to enhance effectiveness in the operating room. How can perioperative nurses provide safe, high quality care to patients without over spending? This poster will illustrate how staff in the Orthopaedic service is able to increase efficiency in total and reverse shoulder arthroplasty. Canada is well-known for having a publicly funded healthcare system, which makes controlling costs a highly profiled issue. Funding is provided by provincial and local health networks who are accountable for the provision of health services. In 2012, Ontario moved to Quality-Based Procedure (QBP) funding. Hospitals are assigned a specific number procedures with designated financial backing. QBP funds support the hospital for shoulder arthroplasty to meet the needs of the surrounding population. Improvements can transpire in staff performance and time. In a community hospital with limited staff, perioperative nurses need to be competent in numerous services with various surgeon preferences. Annually, the Orthopaedic service performs roughly 2-3 shoulder arthroplasty cases per month. The challenge for perioperative nurses is to practice at the level of expert in cases performed infrequently. Successfully adhering to the QBP budget, and maximizing the allotted funds, requires collaboration with surgeons and the OR Business and Inventory Managers. With limited procedures, it is imperative to fully understand the QBP funding allocation specifically to shoulder surgery. Utilizing OR case costing data ensures the average spend per surgery measures up to the benchmark across hospitals in the province. Choosing Wisely Canada is a national campaign that originated from the United States. It is an initiative to provide best practice recommendations to decrease wasteful spending and conserve resources for patients with the greatest need. Improving efficiencies relate to the practice of the surgical team. The practice enhancements involve pathology, team briefings, resources, simultaneous efforts/actions and patient flow. The recommendation to not routinely send arthritic bone to pathology was implemented thus, nurses no longer needed to fill out specimen forms and were able to complete other tasks. To ensure the OR nurses were prepared, briefings occurred with the orthopaedic charge nurse prior to the actual procedure. Resources such as table set-ups and surgeon preference lists were also readily available. Communication played an important role in the success of the surgical team. The challenge with QBP funding is the inclusion costs of the patient’s length of stay in a hospital. Improved staff performance can be further explored through the use of video. Although platforms such as YouTube exist, the videos are not tailored to surgeon specifics. The poster will display the outcomes and percentages of cost savings, effectiveness of changing practice in terms of time saved, and staff satisfaction.