Upcoming efforts to improve Saint Joseph OR efficiency
By Benjamin Foreman, DO, MS, FACS, Chair, Saint Joseph Department of Surgery
I want to take a moment and provide some updates to the presurgical workflow at SJH that are aimed to improve our OR efficiency - specifically, our on-time first-case starts.
Delays in first-case starts have been identified by our leadership as an area of opportunity to facilitate overall improved OR efficiency, accommodate urgent/emergent add-ons, and eventually increase our elective case capacity.
Some of these interventions are undergoing a soft rollout currently. Full implementation of these interventions is targeted for Monday, March 16. Both items, explained below, are for elective first-case starts only.
#1: Pre-op order entry
OR nursing and anesthesia will finalize the following day's elective cases by 5 p.m. We (the surgeons/residents/APPs) have been asked to make sure all preop orders are entered after this time, up until 6:50 a.m. the morning of surgery. These orders can be placed by the surgeon, an APP or resident. Delays associated with late medication orders are a significant driver of delayed on-time first-case starts. Examples of preop orders: antibiotics, any special IV agents (IG Green), any specific analgesic or antiemetic agent protocols. The surgical team is NOT being asked to order all preop pain medications unless specific agents are desired. Otherwise, these agents will be ordered by our anesthesia team, following the same time guidelines listed above.
#2: Cause of delay
When a patient enters the room after 7:30 a.m. (or 8:30 a.m. on Tuesdays), the OR nurse circulator will enter a reason for the delay. There are several categories to which a delay can be attributed. The cause of the delay will be discussed and assigned at the second, post-induction surgical timeout and entered into Epic. The purpose of assigning a delay is not to blame/humiliate/point fingers at any one party; it is to help identify processes that can be improved and help drive our overall efficiency throughout the OR space.
Thank you for your attention to these updates and for your partnership in improving OR efficiency.