Improving flow in the OR

• Published in: International journal of health care quality assurance 2018-03, Vol.31 (2), p.150-161
• Main Authors: Blouin-Delisle, Charles Hubert, Drolet, Renee, Gagnon, Serge, Turcotte, Stephane, Boutet, Sylvie, Coulombe, Martin, Daneau, Eric
• Format: Article
• Language: English
• Subjects: Aged; Anesthesiologists - organization & administration; Bone surgery; Business process reengineering; Clinical pathways; Communication; Efficiency; Efficiency, Organizational; Elective surgery; Female; Health administration; Hospitalization; Hospitals; Humans; Intensive care; Lean manufacturing; Length of stay; Male; Middle Aged; Mortality; Nurses; Nursing Staff, Hospital - organization & administration; Operating Rooms - organization & administration; Patient Admission; Patients; Quality Improvement - organization & administration; Quality of care; Quebec; Recovery; Recovery Room - organization & administration; Retrospective Studies; Surgery; Time Factors; Workflow; Workforce planning
• ISSN: 0952-6862; 1758-6542
• DOI: 10.1108/IJHCQA-01-2017-0014

Purpose The purpose of this paper is to increase efficiency in ORs without affecting quality of care by improving the workflow processes. Administrative processes independent of the surgical act can be challenging and may lead to clinical impacts such as increasing delays. The authors hypothesized that a Lean project could improve efficiency of surgical processes by reducing the length of stays in the recovery ward. Design/methodology/approach Two similar Lean projects were performed in the surgery departments of two hospitals of the Centre Hospitalier Universitaire de Québec: Hôtel Dieu de Quebec (HDQ) and Hôpital de l'Enfant Jesus (HEJ). The HDQ project designed around a Define, Measure, Analyse, Improve and Control process revision and a Kaizen workshop focused on patients who were hospitalized in a specific care unit after surgery and the HEJ project targeted patients in a post-operative ambulatory context. The recovery ward output delay was measured retrospectively before and after project. Findings For the HDQ Lean project, wasted time in the recovery ward was reduced by 62 minutes (68 percent reduction) between the two groups. The authors also observed an increase of about 25 percent of all admissions made in the daytime after the project compared to the time period before the project. For the HEJ Lean project, time passed in the recovery ward was reduced by 6 min (29 percent reduction). Originality/value These projects produced an improvement in the flow of the OR without targeting clinical practices in the OR itself. They demonstrated that change in administrative processes can have a great impact on the flow of clinical pathways and highlight the need for comprehensive and precise monitoring of every step of the elective surgery patient trajectory.