Publish Date: July 24, 2019
First case on-time starts were once a stubborn metric to improve for perioperative teams at Bayhealth Kent General Hospital in Dover, Del. In 2016 teams were averaging 37% of on-time starts of the first surgical case.
That same year a multidisciplinary perioperative team implemented daily huddles, and delays causing timely first case on-time starts came up for discussion in daily huddle conversation, said Carol Leon, MSN, RN, CNOR, NEA-BC, senior OR nurse manager and Judy Mitchell BSN, RN, CNOR, OR clinical coordinator.
“Team members were frustrated with delays and surgeons who were hesitant to arrive on time and risk having to wait for other pieces to come together prior to surgery,” Leon explains. “We know daily huddles give team members a chance to talk about what the team is doing well and what needs improvement and on-time starts proved an important area to improve.”
Using the Daily Huddle to Improve On-Time Starts
Each morning at 9:00am and each afternoon at 1:30pm, a multidisciplinary team representing nursing, anesthesia, and areas including OR, PACU, Day Surgery and Endoscopy at Bayhealth Kent General Hospital gather for a 15-minute huddle.
The morning huddle is used to understand any immediate issues in real time and to assess how the first surgeries of the day starting between 7:15 to 9:00 are moving. The afternoon huddle is used to assess the next three days of surgical cases to flag any missing paperwork, insurance authorizations or patient care needs.
Any practice issues are discussed during the huddle, and Mitchell takes note of certain issues, including surgical delays, to compare against delays noted in the electronic health record. Leon also keeps a manual report of delayed on-time starts as a second way to understand the causes for delays.
Sharing Huddle Data to Drive Change
Through the huddle and the dual processes for tracking delays, Leon, Mitchell and colleagues have been able to identify several key trends causing first case delays, including:
- missing informed consent
- missing H&P or interval note
- late surgeon arrival time
Causes for surgery delays, including for first cases, as well as other productivity metrics are shared to help teams celebrate successes and be aware of areas for improvement.
Surgeon performance with on-time starts will soon be posted in the surgeon lounge for each surgeon to see their performance alongside the performance of their surgeon peers. For example, stats for number of times a surgeon was late to a surgery will be shared. “This team understanding of the statistics gets people talking and can be easily shared at the executive level to hold team members accountable.”
This combined work to track first case on-time starts that spearheaded from the daily huddles has led to significant improvements, including:
- Seven months after starting the daily huddles, first case on-time starts increased from 37% to 70%.
- On-time starts were consistently maintained in the high 80 percent range two years after huddle implementation.
- The current monthly average goal of 92% of first-cases starting on time has been met in February and March with an average between high 80% to 90% for the past few months.
Improving the Power of the Huddle
Leon and Mitchell admit that it took time to get the staff engaged to share information or concerns in the staff huddle and to think about efficiency, delays and associated costs to patient safety and the organization.
“We have the support at the executive level from nursing and from our medical director for this ongoing improvement work to support any concerns and to support a culture in which every team member is expected to speak up with a concern,” Mitchell acknowledges.
Leon says the huddle has become a welcomed moment to engage all team members. “It’s common to hear, ‘let’s take it to the 9:00.’ The huddle is always on our minds to help us understand where we can work together to improve care for our patients.”
Advice to Leaders
Building a strong huddle culture doesn’t happen overnight, Leon stresses, “you have to be persistent, stay the course and understand it will take time and everyone supporting each other.” If you are just starting the work to implement daily huddles and tackle a multifaceted metric such as first case on-time starts, she suggests making sure to identify key people you know can make a difference and help you reach a shared improvement goal.
“Make sure to keep your huddle open to anyone,” Mitchell adds. She says the key to a successful huddle is collaboration and open communication with every staff member because “numbers are one thing but it’s the people behind the numbers who make improvements happen.”
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