Surgical Improvement Project

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Surgical Improvement Project

• SIP 2 Data Analysis

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Key Metrics - Analysis
Location Check in to Anes Start (min) Anest Start to In-room (min) In-room to Anes Ready (min) Anes Ready to Incision (min)
Main OR 98 23 19 27
Pavilion 84 16 13 21
Annex 85 23 15 23
Wednesday late start day, data removed
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Variation by Service
Service Check-in to Incision (min - mean) SD
Neurosurg 199.4 25.9
Oto 162.6 7.1
Surg C 162.0 7.2
Orthopedics 159.4 16.6
Gen Surg 156.0 9.6
Gyn 145.8 14.9
Ophthalmology 128.6 4.3
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Patient Readiness Grid
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SIP2 Problem Statements RPI 5S SIP2 JDI
Emergent/transplant impact on schedule X    
Incomplete Patient Orders X    
Surgeon "in house" requirement delays     X
Concentration of case prep between 0600 0715 X    
Incomplete documentation X    
Patient not ready for surgery X    
Wrong case cart X    
Late starts due to anesthesia resident availability X    
Transport delays X    
Duplication of documentation     X
Timing of teaching X    
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Patient in Pavilion Pre-OP till HA Pick-up
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Patient in OR
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Process Walk-Patient in Holding
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Process Walk - Patient in OR
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Summary

• Agreement on definitions of times essential.
• Billing times do not necessarily indicate work
  times (ie. Anesthesia start time based on billing
  time, not actual time)
• Data indicates consistency of late starts at all
  sites.
• Greatest delay, and greatest pain in the Main
  OR.
• Variation in time (SD) for the different sites,
  days of week, and overall steps in the process
  Check-in to Anest start, Anest start to In-room,
  In-room to Anest ready, and Anest ready to
  Incision - are relatively uniform and small,
  (15-20 min)
• Delay and variation analysis by
• Service (
• Type of procedure (delay for craniotomy, spine,
  gastric bypass are outliers)
• shows some services and types of patients have
  greater variation and delay
• 1/2 to 2/3 of time is spent between patient
  arrival and Anesthesia start.
• Mismatch between Preanesthesia Clinic criteria
  for pt. arrival (based on complexity of patient
  and amount of preop preparation) and Main OR
  Transport criteria to the Main OR Preanesthesia
  area (Gales area).
• Mismatch between anesthesia staff arrival time
  and expectations for anesthesia start time.
• Anesthesia faculty over committed to start two
  rooms simultaneously.