424 - PIPE Your Flow

in patient flow.When surgery patients begin to clog patient flow in the hospital, delays can cause overall pressure on inpatient units and hospital services. To explain the framework for efficiency discussed in this article, patient flow will be referred to as water flowing through a pipe. A smooth flow of water through a pipe is demonstrated when nothing blocks the passage inside the pipe and nothing pushes on the outside of the pipe to nar- row the passage of water. If something inside the pipe or an unwanted force pushing on the outside of the pipe occurs, smooth flow is restricted, and less water can pass through, thus causing a clogged or inefficient flow. This metaphor allows us to imagine a similar flow when describing effi- ciencies through the OR. If barriers inside or outside of the OR occur, a decrease in patient flow occurs, patient clogging results and it effects the entire facility. This article focuses on four areas of perioperative care which should be considered to decrease clogging and increase flow efficiencies: The first section is named “P¹” and identifies pre-care considerations and activities. The second is “I” indicating interoperative ideas to improve effective delivery within the OR suite. The third is “P²” and stands for post-care considerations, which aid in faster recovery time and care efficiencies to discharge patients earlier. Lastly, “E” is meant to highlight efficiency across the peri-op process by understanding the foundational prac- tices needed to accomplish elements in the first three areas. P¹ - Pre-op: The key to a smooth intra-operative experience and posi- tive patient outcome begins at the surgical pre-op phase. In this phase, the surgical procedure is scheduled and pre-op testing is performed (when medically necessary). Obtain- ing and providing the surgical department with timely and accurate patient information aids in optimal use of oper- ating rooms, equipment and staff. “Studies have demon- strated that failure to implement an effective pre-surgical screening process leads to higher rates of same-day cancel- lations and late starts, incomplete and over-ordered testing, patient dissatisfaction and staff frustration. 13 Appropriate pre-testing, an up-to-date patient H&P, consent for surgery and proper scheduling eliminates potential cancellations and delays. Authors of a recent white paper for the Insti- tute for Healthcare Improvement (IHI) discussed a variety of principles for improving hospital-wide patient flow. 12 One such principle explains how hospitals can invest time and resources into learning how to shape their demands by expanding the operating room scheduling system capabili- ties to be more predictive. Predictive or advanced data ana- lytics can be used to reduce not only scheduling variations, but forecast demand patterns, assist in planning for appro- priate staffing levels and define bed management plans for patients who require special needs or higher levels of care post-surgery. As noted by a variety of researchers, moving to a more proactive stance when scheduling and prepping patients appropriately, surgeons and staff have proven to be more successful at achieving workflow goals. One study by the University of Pittsburg Medical Center in collabora- tion with IHI, reports improvement in hospital-wide patient flow using their predictive bed management program. This program demonstrated shorter wait times for patient-to- bed placement post-surgery; therefore, safer, more reliable patient outcomes were achieved. 12 Likewise, instructing patients in advance about after- care needs demonstrated success across a variety of surgical procedures. For instance, discussing post-care while already in the physician’s office has proven to provide patients with more clarity because they are in a more familiar environ- ment. Most agree it is easier to co-build a safe space and transparency with family members or significant others prior to the surgical procedure. It provides a way to set patient expectations for post-discharge care and potential therapy planning including how much time is involved for recovery to a normal level of wellness. Pre-surgical instruc- tions not only help to define true informed consent, but it also aids in anticipating barriers. Although slow in adoption among many surgeons, some support the use of Enhanced Recovery After Surgery (ERAS) planning as part of their pre-op regiment. ERAS are … “ ... multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery. The key elements of ERAS protocols include preoperative coun- seling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization.” 11 Whether hospitals use pre-op testing, block surgery scheduling or ERAS, the principle of anticipating and plan- ning to assist patients in meeting their desired outcome is the goal. Once there is a clear understanding of the path, the care team’s goal is making a smooth path so as not to impede effective progression of care. | The Surgical Technologist | APRIL 2019 160