Departments of Anesthesiology and Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; and
Departments of Anesthesiology and Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; and.
Pediatrics. 2015 May;135(5):e1292-9. doi: 10.1542/peds.2014-2418. Epub 2015 Apr 13.
Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation.
Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and text-message reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods.
Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites.
By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization.
手术当天取消（DoSC）会浪费宝贵的手术室（OR）时间，给患者家庭带来不便、情绪困扰和经济负担。本质量改进项目旨在减少因取消手术而导致的手术室时间损失。
该过程的关键驱动因素包括与患者家庭进行有效的双向沟通、遵守禁食规定，以及在手术当天之前对患者病情做出决策。一个多学科团队对各种关键驱动因素进行了一系列的变更测试。干预措施包括简化、彩色、个性化的术前指导单，并向照顾者的手机发送短信提醒，以及制定明确的机构决策途径，以便在患者病情出现问题时在手术当天之前重新安排手术。在初始的小规模测试之后，这些干预措施在所有患者和地点实施。数据从医院信息技术系统中收集，并使用控制图和统计过程控制方法进行分析。
DoSC 导致的平均手术室时间损失从医院基地校园部分外科服务的基线 5.7 小时/天减少到测试时的 3.6 小时/天，然后在所有外科服务都实施时从 6.6 小时减少到 5.5 小时/天。
通过应用质量改进方法，显著减少了因 DoSC 而导致的手术室时间损失。通过改善机构资源利用，这种影响可能是显著的。
