Journal Article

Utilization of lean project management principles and health informatics to reduce operating room delays in a vascular surgery practice

Shaw, Maxwell, McPherson, Rachel, Gupta, Ryan, O'Brien, Jaime, Tat, Quy, de la Cruz, Daniella, Dua, Anahita, Cumbler, Ethan, Yi, Jeniann A.

2022

Overview

Perioperative inefficiency can increase cost. We describe a process improvement initiative that addressed preoperative delays on an academic vascular surgery service. First case vascular surgeries from July 2019–January 2020 were retrospectively reviewed for delays, defined as late arrival to the operating room (OR). A stakeholder group spearheaded by a surgeon-informaticist analyzed this process and implemented a novel electronic medical records (EMR) preoperative tool with improved preoperative workflow and role delegation; results were reviewed for 3 months after implementation. 57% of cases had first case on-time starts with average delay of 19 min. Inappropriate preoperative orders were identified as a dominant delay source (average delay = 38 min). Three months post-implementation, 53% of first cases had on-time starts with average delay of 11 min (P < 0.05). No delays were due to missing orders. Inconsistent preoperative workflows led to inappropriate orders and delays, increasing cost and decreasing quality. A novel EMR tool subsequently reduced delays with projected savings of $1,200/case. Workflow standardization utilizing informatics can increase efficiency, raising the value of surgical care. •Standardization of workflows is a critical quality improvement tool.•Inconsistent results can decrease the quality and value of patient care.•Informatics can be utilized to study issues and implement change in healthcare.•Perioperative inefficiency is a major source of waste in healthcare.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Academic Medical Centers - economics / Academic Medical Centers - organization & administration / Academic Medical Centers - statistics & numerical data / Anesthesia / Automation / Collaboration / Consent / Coronaviruses / Cost control / Cost Savings - statistics & numerical data / COVID-19 / Delay / Efficiency / Efficiency, Organizational - economics / Efficiency, Organizational - standards / Efficiency, Organizational - statistics & numerical data / Electronic health records / Electronic medical records / Health Plan Implementation - organization & administration / Health Plan Implementation - statistics & numerical data / Hospital systems / Hospitals / Humans / Informatics / Lean management / Lean manufacturing / Medical Informatics / Operating Rooms - economics / Operating Rooms - organization & administration / Operating Rooms - standards / Operating Rooms - statistics & numerical data / Pandemics / Patients / Perioperative delay / Perioperative efficiency / Practice Guidelines as Topic / Program Evaluation / Project management / Quality control / Quality Improvement / Retrospective Studies / Reviews / Root Cause Analysis - statistics & numerical data / Six Sigma / Stakeholders / Standardization / Surgery / Trends / Vascular surgery / Vascular Surgical Procedures - economics / Vascular Surgical Procedures - organization & administration / Vascular Surgical Procedures - statistics & numerical data / Workflow