Reducing Patient Delays in the Preoperative Unit: A Quality Improvement Approach

BACKGROUND: The preoperative department is the area where patients undergo final preparations for surgery. For patients already in the hospital setting, it is important for several assessments and interventions to take place prior to their arrival in the preoperative department. The use of a preoperative checklist is believed to help determine it is safe for patients to undergo the procedure they are scheduled for and that it is safe for them to undergo that procedure.

LOCAL PROBLEM: The setting of this quality improvement project was a Level I Trauma Center in the Eastern Tennessee region. The project site had 33 operating rooms and serviced more than 10 surgical specialties. Approximately 20% of cancelled and delayed surgeries were due to preventable causes. Recent studies showed standardized patient handoff improved patient readiness for surgery and the World Health Organization recommended implementation of surgical checklist improved patient outcomes and operating room efficiency. The purpose of this project was to evaluate the effectiveness of an improved and standardized perioperative checklist compared to the current practice.

METHODS: The Model for Improvement (MFI) served as the framework for project implementation. The clinical workflow for utilizing the preoperative checklist and for patient handoff was determined through PDSA (Plan-Do-Study-Act) cycles. Pre- and post-implementation data were measured to evaluate effectiveness in reducing cancelled and delayed surgeries.

INTERVENTIONS: Education about preventable causes of delayed and cancelled surgeries was provided to nursing staff. An improved preoperative checklist was developed to be completed by nursing staff prior to patient surgery and a new patient handoff process was implemented.

RESULTS: Analysis of the data showed a reduction in time patients spent in the preoperative unit was approximately 17 minutes and the reduction of cancelled surgeries was 5%, illustrating improved patient readiness for surgery. While this was not statistically significant, what this meant for efficient utilizations of space and resources for the department had clinical significance for stakeholders.

CONCLUSIONS: Implementing a standardized preoperative checklist and patient handoff process did not have statistical significance but was clinically significant. This new process improved patient readiness for surgery and did diminish time patients spent in the preoperative unit as well and decrease cancelled surgeries. Sustainability plans include implementing the new process and checklist to all patient units at the project site.