Expectations
Isn’t it great to show up to the operating room (OR) without anxiety and worry, knowing the first cases are ready to go and being assured your day will be smooth sailing! Wait…what do you mean that’s not usually how it works?! Are you saying you’re frustrated and stressed out that everyone and everything isn’t as it should be and your day is off to a rocky start even before you walk through the door? How can perioperative services change this reoccurring scenario?
Getting Started
Rest assured, there are a few key things that can be changed in the daily process of the OR to help prevent the seemingly inevitable choas. Let’s take a closer look.
Have you thought that maybe the way you are looking at and preparing for first cases could use a bit of an upgrade? One of the best ways to accomplishing this is to build the framework for a multi-departmental team to briefly gather daily and review cases before the day of surgery. We like to call this the collaborative daily review. While you may be thinking “we already get together in our morning shift review,” this is a bit different.
Nuts & Bolts
The first step to building the framework for a collaborative daily review is to look at which departments in the hospital or ASC, affect patient care. These departments should include Scheduling, PAT, preop, OR Staff, anesthesia, sterile processing, materials, and the surgeon.
All of these departments and key players have interactions with the patient and have a responsibility to perform at the top of their game to ensure things get underway in an efficient and safe manner. Each player is expecting the previous team to have completed the necessary functions and preparations to enable the patient to move to the next phase in the perioperative process. If something doesn’t go right or a key player drops the ball, everyone needs to be aware as soon as possible to ensure things can be re-organized in order to keep things moving forward. At the end of the process; the surgeon, anesthesia, and OR staff are standing at the ready to receive the patient for their procedure only when everything else has gone to plan without any delays.
As you can probably tell by now, communication is a big part of the framework. When all departments come together at the same time and all hear the same thing, it has a profound impact on patient preparation and readiness on the day of surgery.
A commitment from all departments to attend each day is vital to its success. Best practice is to have reviews that don’t take more than 30 minutes, so as not to add to already tight schedules. It is usually most beneficial to meet immediately before or after the close of the next day’s schedule and to allow time to review the following 5 days. During the review, the goal is to review the schedule to remove barriers and prevent potential unforeseen delays.
An example of a specific delay to address may be that the first patient is from a long term care (LTC) facility. Knowing that most hospitals require patients to arrive at the hospital 1½ to 2 hours before the scheduled time and also being aware that your hospital routinely struggles to have this patient population arrive at the required time for first cases, it might be beneficial to move this patient to the second case of the day. By doing this proactively, you are preventing a possible delay, not only for this first patient, but for all subsequent patients to follow in that OR.
When all departments involved in the collaborative daily review hear that the patient order has changed, Preop will know not to expect that patient as the first patient and will be ready for the correct patient to arrive. The SPD/materials will know to prepare for a different surgical case as the first case, ultimately leading to the OR staff not be waiting idly by for a case that isn’t coming.
Missing information and poor communication has a huge impact of resources and staff satisfaction. After all, time is money and a satisfied, resourceful staff is able to use their time more wisely.
Ready for Success
Make sure to enforce the collaborative daily review as a priority for all the departments and players who impact the patient’s journey, start reviewing the schedule and catch those potential barriers to a successful and satisfying day in the OR.
