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Small Changes Equal Big Payoff
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care using an inpatient and perioperative model. The Unit improved flexibility by working through a rapid cycle improvement process. Creation of the unit also expanded the role of Advanced Practice Nurses in Perioperative Services.
SMALL CHANGES EQUAL BIG PAYOFF Team Leader: Cindy Hain, RN, CPAN, CAPA University of Colorado Health, Poudre Valley Hospital, Fort Collins, CO Team Member: Carla Thorson, RN-BC, MSN, CNOR
A rapid improvement event (RIE) targeted to improve turnover times in the operating rooms directly impacted the practice of PACU nurses. The RIE showed inefficiencies and redundancies among team members and throughout the surgical process. Patients were connected and disconnected to blood pressure cuffs three different times during the perioperative experience. Multiple reports were given to PACU nurses from the OR nurse and anesthesia. The objectives of the project were to decrease OR turnover times, find and maximize efficiencies throughout the surgical patient’s journey and eliminate redundancies in process and improve staff satisfaction. Several experiments were implemented after reviewing the process and identifying areas to improve. Vital sign equipment was standardized and adaptors acquired so the blood pressure cuff could be placed once and remain in place for entire perioperative experience. Standard work was developed for team members that defined roles and reduced redundancies increasing efficiencies during patient hand offs. The handoff between the OR and PACU nurse was eliminated and anesthesia reported all pertinent information in their hand off. This enabled the PACU nurse to expedite pain management and assessment of post surgical needs 5-7 minutes sooner. Having the blood pressure cuff already in place saved 1-2 minutes leading to faster assessment of vital signs and increased quality of patient care management and increased staff satisfaction.
HUDDLE FOR IMPROVED STAFF PRODUCTIVITY Elizabeth L’Hommedieu, BSN, RN, CPAN, Elizabeth Govero, MSN, RN, CMSRN Barnes-Jewish Hospital, St. Louis, MO Purpose: Our large post-anesthesia care unit (PACU) recently experienced a combination of increased staff vacancy and a higher number of surgery cases. This caused patients to be held in the operating room (OR) after surgery. The PACU leadership team decided to assess staff allocation daily. The goal was to fill the variable needs of the unit and to better utilize all staff members. Implementation: After reviewing staff vacancies and daily scheduled cases in all phases of our PACU, staff redistribution would be discussed. This would take place during a short “huddle” with the charge nurses from four patient care areas: Pre-op, Phase I, Phase 2 and PCCA (Post-anesthesia Critical Care Area). A daily plan was drawn up at the “huddle” to cover our peak hours between 1pm and 5pm. Staff members would be floated between all of the perioperative areas as needed to avoid OR delays and better support staff in busier areas. During the day, communication took place between charge nurses to deter-
ASPAN NATIONAL CONFERENCE ABSTRACTS mine when staff would be available to relocate and to continue to assess the needs of the entire PACU. Evaluation: The process has been in place for three months. We are still experiencing more than average staff vacancies, however by shifting staff members to other phases of care during peak hours it has decreased the time of OR holds. It has also provided more staff support during the busiest hours of the day. Newly hired staff members are currently being cross-trained in all phases of perioperative care.
FLASHING RESULTS IN GREATER PATIENT AND STAFF SATISFACTION Cindy Ladner, BSN, MBA, CAPA, CASC, Tracy Summers, RN Shawnee Mission Medical Center, Shawnee Mission, KS Marcia Becker, RN, Christy Burns, RN, Cheryl Van Dam, RN, BS, CPAN, Kaela Morgan, BS, BSN
Our multispecialty Surgery Center’s vision is to be recognized as a leader in ambulatory surgery with unsurpassed clinical quality and patient satisfaction in the top ten percentile nationally. In order to achieve our goal for patient satisfaction, we looked for opportunities that would positively impact our patient’s experience. The focus on staff communication was our objective to improving and hardwiring our patient’s experience. Our team implemented a communication process consisting of a multidisciplinary “Flash” meeting each afternoon limited to ten to fifteen minutes. Our “Flash” meetings are in addition to “Safety Huddles” held at the beginning of the day. These “Flash” meetings brought our communication efforts full circle with involving members from our multidisciplinary team. Meeting later in the day helps to evaluate outcomes and anticipate needs for the following day. Meeting agenda includes: Evaluation of patient throughput issues from registration through discharge Review of “Patient Specifics Daily Log” initiated for the next day and address any patient special needs that may impact patient care Review next day surgery schedule and make plans to meet the needs of our patient and staff Staff recognition for accomplishments Our overall patient satisfaction scores have demonstrated consistent positive results. It has promoted patient throughput and open communication between departments. This has provided an opportunity to recognize staff across departments. Our focus on communication has enhanced not only our patient’s experience of their care, but also improved staff satisfaction and involvement to improving patient care.
OPERATING ROOM HOLDS: HOW ONE PACU WORKED COLLABORATIVELY TO REDUCE THIS PROBLEM Team Leader: Kathleen Duckworth, RN, CPAN Lehigh Valley Health Network Allentown, PA Team Member: Jodi Koch, RN, BSN
When hospital census is at maximum capacity, it becomes challenging to keep efficient throughput through the Operating
care using an inpatient and perioperative model. The Unit improved flexibility by working through a rapid cycle improvement process. Creation of the unit also expanded the role of Advanced Practice Nurses in Perioperative Services.
SMALL CHANGES EQUAL BIG PAYOFF Team Leader: Cindy Hain, RN, CPAN, CAPA University of Colorado Health, Poudre Valley Hospital, Fort Collins, CO Team Member: Carla Thorson, RN-BC, MSN, CNOR
A rapid improvement event (RIE) targeted to improve turnover times in the operating rooms directly impacted the practice of PACU nurses. The RIE showed inefficiencies and redundancies among team members and throughout the surgical process. Patients were connected and disconnected to blood pressure cuffs three different times during the perioperative experience. Multiple reports were given to PACU nurses from the OR nurse and anesthesia. The objectives of the project were to decrease OR turnover times, find and maximize efficiencies throughout the surgical patient’s journey and eliminate redundancies in process and improve staff satisfaction. Several experiments were implemented after reviewing the process and identifying areas to improve. Vital sign equipment was standardized and adaptors acquired so the blood pressure cuff could be placed once and remain in place for entire perioperative experience. Standard work was developed for team members that defined roles and reduced redundancies increasing efficiencies during patient hand offs. The handoff between the OR and PACU nurse was eliminated and anesthesia reported all pertinent information in their hand off. This enabled the PACU nurse to expedite pain management and assessment of post surgical needs 5-7 minutes sooner. Having the blood pressure cuff already in place saved 1-2 minutes leading to faster assessment of vital signs and increased quality of patient care management and increased staff satisfaction.
HUDDLE FOR IMPROVED STAFF PRODUCTIVITY Elizabeth L’Hommedieu, BSN, RN, CPAN, Elizabeth Govero, MSN, RN, CMSRN Barnes-Jewish Hospital, St. Louis, MO Purpose: Our large post-anesthesia care unit (PACU) recently experienced a combination of increased staff vacancy and a higher number of surgery cases. This caused patients to be held in the operating room (OR) after surgery. The PACU leadership team decided to assess staff allocation daily. The goal was to fill the variable needs of the unit and to better utilize all staff members. Implementation: After reviewing staff vacancies and daily scheduled cases in all phases of our PACU, staff redistribution would be discussed. This would take place during a short “huddle” with the charge nurses from four patient care areas: Pre-op, Phase I, Phase 2 and PCCA (Post-anesthesia Critical Care Area). A daily plan was drawn up at the “huddle” to cover our peak hours between 1pm and 5pm. Staff members would be floated between all of the perioperative areas as needed to avoid OR delays and better support staff in busier areas. During the day, communication took place between charge nurses to deter-
ASPAN NATIONAL CONFERENCE ABSTRACTS mine when staff would be available to relocate and to continue to assess the needs of the entire PACU. Evaluation: The process has been in place for three months. We are still experiencing more than average staff vacancies, however by shifting staff members to other phases of care during peak hours it has decreased the time of OR holds. It has also provided more staff support during the busiest hours of the day. Newly hired staff members are currently being cross-trained in all phases of perioperative care.
FLASHING RESULTS IN GREATER PATIENT AND STAFF SATISFACTION Cindy Ladner, BSN, MBA, CAPA, CASC, Tracy Summers, RN Shawnee Mission Medical Center, Shawnee Mission, KS Marcia Becker, RN, Christy Burns, RN, Cheryl Van Dam, RN, BS, CPAN, Kaela Morgan, BS, BSN
Our multispecialty Surgery Center’s vision is to be recognized as a leader in ambulatory surgery with unsurpassed clinical quality and patient satisfaction in the top ten percentile nationally. In order to achieve our goal for patient satisfaction, we looked for opportunities that would positively impact our patient’s experience. The focus on staff communication was our objective to improving and hardwiring our patient’s experience. Our team implemented a communication process consisting of a multidisciplinary “Flash” meeting each afternoon limited to ten to fifteen minutes. Our “Flash” meetings are in addition to “Safety Huddles” held at the beginning of the day. These “Flash” meetings brought our communication efforts full circle with involving members from our multidisciplinary team. Meeting later in the day helps to evaluate outcomes and anticipate needs for the following day. Meeting agenda includes: Evaluation of patient throughput issues from registration through discharge Review of “Patient Specifics Daily Log” initiated for the next day and address any patient special needs that may impact patient care Review next day surgery schedule and make plans to meet the needs of our patient and staff Staff recognition for accomplishments Our overall patient satisfaction scores have demonstrated consistent positive results. It has promoted patient throughput and open communication between departments. This has provided an opportunity to recognize staff across departments. Our focus on communication has enhanced not only our patient’s experience of their care, but also improved staff satisfaction and involvement to improving patient care.
OPERATING ROOM HOLDS: HOW ONE PACU WORKED COLLABORATIVELY TO REDUCE THIS PROBLEM Team Leader: Kathleen Duckworth, RN, CPAN Lehigh Valley Health Network Allentown, PA Team Member: Jodi Koch, RN, BSN
When hospital census is at maximum capacity, it becomes challenging to keep efficient throughput through the Operating