198 - Multidisciplinary Initiative to Decrease Non-operative Patient Time in the Operating Room
Description: An area of improvement was recognized for reducing the amount of non-operative time in the cardiac operating room. A collaborative, multidisciplinary team approach comprised of cardiac surgeons, cardiac anesthesia, cardio-pulmonary perfusion, and cardiac operating room nurses, met to identify areas that were creating delays. In effort to streamline a process that would allow each area to work in parallel rather than in sequence, strategies to improve effectiveness were determined. Establishing a goal timeline of when tasks should be completed was imperative in staying on target as well as being able to implement the new process. A retrospective study was completed to establish the previous six months average time for the non-operative portion for first case open heart surgeries. This allowed for the team to establish a baseline average of 79.82 minutes until surgery start. The total time is shared by anesthesia, nursing and other disciplinarians completing their respected responsibilities prior to the operative phase. The nurses would be responsible for tracking items that would cause any delay that had a negative impact on efficiency. A goal of 60 minutes was established for over the following six month period. Upon implementation, the operating room nurses would make contact with the patient earlier to identify obstacles that needed to be addressed in order to eliminate a delay to entering the room. Anesthesia produced guidelines to limit the amount of time for induction and line placement, while still allowing for teaching of the fellows and residents. Anesthesia would also be able to insert the ECHO probe if the cardiologist was unavailable at the necessary time. The perfusion team would use an alternate access point for any blood draws needed that would limit timely patient positioning. Implementing small, but calculated changes would in turn generate a more productive environment to reach the operative phase sooner. The benefits to creating an environment that is synergistic in nature has multiple implications for perioperative team and the patient. First, it decreases the amount of time patients are under general anesthesia while waiting for the procedure to start and reduces costs. Other impacts include improvement of productivity in streamlining processes and allowing the ability to identify obstacles that may be present. In addition, it increases the ability for effective communication between the different disciplinarians that are present in the cardiac operating rooms, as well as provides an environment that promotes growth through active participation toward contributions to the betterment of the team as a whole.