How Preoperative Preparation Can Drive OR Performance

The operating room is a hectic, busy place. One way to make the OR more efficient is to focus on preoperative functions, such as case scheduling accuracy, completing patients' charts and proactive communication with the appropriate staff and physicians. "Preoperative patient preparation with reasonable lead time is one of the largest drivers of efficient OR performance," says Robert Stiefel, MD, principal of management and consulting firm Enhance Healthcare. However, it is "all too common for many preoperative components to be left to the day of surgery."

Dr. Stiefel describes the preoperative period as a "series of interrelated processes" that involve the coordination of multiple people and service lines. "If any of these processes fall through the cracks, you set yourself up for the potential [to have] a patient who needs additional workup on the day of surgery, unexpected delays and cancellation." He outlines some key preoperative responsibilities that can improve intraoperative metrics, including start times, turnover time and OR utilization.

1. Schedule efficiently.
"Efficiency starts at the point of scheduling," Dr. Stiefel says. For elective cases, the more time between a patient's scheduling and his or her surgery, the more time staff and physicians have to gather information and optimize the patient for surgery. In addition, to manage patient flow and efficiency on the day of surgery, scheduling staff should use software that accurately estimates the average time each surgeon takes to perform a given procedure in order to schedule cases, plan patient arrival times and allocate OR start times in a realistic manner.

2. Create and complete preoperative protocols.
Anesthesia providers should guide the creation of preoperative protocols for lab/imaging tests based on patient and procedure characteristics. A clear understanding of expected testing data should be disseminated to all surgeons and preoperative testing personnel. Once the patient is evaluated in the pre-admission testing area, the required testing should be identified, expedited and documented on the chart for review no later than the business day prior to surgery, Dr. Stiefel says. The protocols for testing can minimize both excessive testing and under-testing, providing more consistent, efficient and evidence-based care, he says.     

3. Complete charts early. Dr. Stiefel recommends completing and reviewing a patient's chart by the day prior to surgery to ensure that all required testing, documentation and consultations are in place and issues addressed. This preparation will help minimize delays the day of surgery. Preoperative testing personnel should develop a data tracking tool to gather accurate patient information in a timely fashion. Dr. Stiefel suggests creating a triage mechanism to decide which patients need to be seen before the surgery. "Anesthesia is normally involved in creating those mechanisms, which are often implemented by nurse practitioners and other nursing and hospital personnel," he says.

4. Communicate to stakeholders. As a patient's chart is being completed, any abnormalities or issues need to be disseminated to the appropriate people so that they may be addressed in a timely manner as far ahead of the day of surgery as possible. Such issues may include lab/imaging abnormalities, testing recommended by consultants or a history of anesthesia-related complications. "The goal is to have the patient arrive on the day of surgery fully prepared with all the required documentation and with issues resolved, Dr Stiefel says. Avoidance of hurried last-minute testing or consultations offers the best chance to provide excellent patient care and maximize OR performance."   

Learn more about Enhance Healthcare.

Related Articles on OR Efficiency:

A Lean Machine: How Lean Methodology Can Streamline OR Processes
Hospital OR Turnover Challenges and Solutions: Q&A With Dr. John Di Capua of North American Partners in Anesthesia and North Shore-LIJ Health System

Dr. Richard Kube: How Spine Surgeons Can Maximize Efficiency of ORs

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