Pashankar Dinesh S, Zhao Anna M, Bathrick Rebecca, Taylor Cindy, Boules Heidi, Cowles Robert A, Grossman Matthew
Section of Gastroenterology, Department of Pediatrics.
Yale University School of Medicine.
Pediatr Qual Saf. 2020 Jun 24;5(4):e305. doi: 10.1097/pq9.0000000000000305. eCollection 2020 Jul-Aug.
Delays in the operating room (OR) can lead to increased hospital costs as well as patient and provider dissatisfaction. Starting the first case on time in the OR can potentially prevent subsequent delays. We designed a quality improvement project to improve the first case on-time starts in the pediatric OR at a tertiary care children's hospital.
Following the collection of baseline data, we formed an interdisciplinary team. We analyzed the causes of delay and used the Six Sigma methodology of Define, Measure, Analyze, Improve, and Control. We identified key drivers and implemented several low-cost interventions using Plan-Do-Study-Act cycles. Major interventions included preoperative care coordination, strategic staggering of OR cases, and introduction of "Wow Bucks" incentives. We monitored start times and the delay in minutes for all first cases weekly. The OR minutes saved per week were calculated and used to estimate cost savings.
We studied a total of 1981 first-start cases from May 2018 to October 2019. The first case on-time starts improved from 62% to 77% over the study period. There was a significant improvement in total minutes delayed for all the first cases from 197.9 minutes per week down to 133 minutes per week ( < 0.05). Estimated cost savings were $4,023 per week due to improved OR utilization.
A multidisciplinary collaborative team approach using quality improvement tools can improve on-time starts in the pediatric OR.
手术室的延误可能导致医院成本增加，以及患者和医护人员的不满。在手术室按时开始第一台手术有可能防止后续的延误。我们设计了一个质量改进项目，以提高一家三级儿童专科医院儿科手术室第一台手术的准时开始率。
在收集基线数据后，我们组建了一个跨学科团队。我们分析了延误的原因，并使用了定义、测量、分析、改进和控制的六西格玛方法。我们确定了关键驱动因素，并使用计划-执行-研究-行动循环实施了几项低成本干预措施。主要干预措施包括术前护理协调、手术室病例的战略错开安排以及引入“哇哦奖金”激励措施。我们每周监测所有第一台手术的开始时间和延误分钟数。计算每周节省的手术室分钟数，并用于估计成本节约情况。
我们研究了2018年5月至2019年10月期间总共1981例首次开始的手术。在研究期间，第一台手术的准时开始率从62%提高到了77%。所有第一台手术的总延误分钟数有了显著改善，从每周197.9分钟降至每周133分钟（<0.05）。由于手术室利用率提高，估计每周节省成本40,23美元。
使用质量改进工具的多学科协作团队方法可以提高儿科手术室的准时开始率。
