HELPFUL HANDOFFS Simple tweaks to staffing assignments will improve communication between the OR and pre-op. The chart below shows how ORs and pre-op beds are linked so nurses in both areas work together throughout the day.

In our teaching hospital, patients used to come into a single pre-op area containing 10 beds before being sent to one of 9 ORs. When patients arrived at registration, we’d pull their charts and place them on the pre-op desk. Nurses would grab the charts and start preparing the patients for surgery on a first-come, first-served basis. There was no organization to the flow and no method for assigning patients to pre-op beds. (Never mind the emergent cases that would further confuse matters.)

The only way to know which nurses were getting which patients ready was to flip through charts. We didn’t like the helter-skelter process, and patients deserved a calmer scene before heading into surgery.

To reach a solution, we first created a team that included representatives from every aspect of perioperative care. We tried to eliminate as many roadblocks as possible, and didn’t accept answers that involved adding staff members.

Match pre-op beds with ORs
Key for us was making use of a secondary pre-op area that contains 8 beds, bumping our total number of pre-op beds to 18. Now, the perioperative lead or charge nurse previews the next day’s surgical schedule and matches pre-op beds with ORs — 2 pre-op beds are assigned to each OR — based on the number and types of cases and expected procedure times. In our case, pairings of 18 pre-op beds staffed by assigned nurses feed patients to one of 9 ORs throughout the day. We give high-volume ORs beds in opposite sides of the pre-op area so as not to impede patient flow. As you can see in the photo, we note the assignments and layout of the pre-op area on a dry erase board for quick reference by the entire surgical team.

Much smoother patient flow
Among the new system’s noticeable improvements:

• Smarter staffing. There was a lot of concern about how we could improve patient flow without increasing manpower. We’ve found that organized assignments eliminate staff running around to locate patients or seek answers to clinical care questions, so the same number of nurses can accomplish more by working smarter, not harder. Before implementing the new system, some nurses would get 10 patients ready in the morning, while others would prep only a couple; there was no way to monitor and record daily workloads. We can now see how hard nurses are working and rotate assignments throughout the week to even out the workload.
• Seamless communication. When questions about a patient’s history or pre-procedure care arise in the OR, there’s nothing more frustrating than calling out to pre-op and waiting 5 minutes until the right nurse is located. The new process has eliminated that hassle because the surgical nurses know exactly whom to call to discuss the care of a specific patient.

You can fix most issues that impact patient flow if you know about them. Nurses in the ORs and at the corresponding pre-op beds now develop a rhythm and rapport throughout the day, which moves patients along more smoothly. For example, patients aren’t always compliant with pre-op directives or might present with unforeseen issues that need to be addressed before surgery can commence. Those issues used to be communicated inefficiently and sporadically. Now, with nurses in the ORs and pre-op area in constant communication, they can react to unforeseen glitches (or efficiencies, for that matter) related to the care of their patients and adjust the surgical schedule on the fly.

• Improved patient safety. Patient handoffs mean more. It’s not that handoffs weren’t occurring or weren’t effective before, but now the 2 nurses communicating during the transfer of care are directly involved in prepping the patient for surgery and have ownership in the case outcome. They’re meeting with firsthand knowledge of what the patient needs and how the case should progress. There’s meaning behind the words that appear in the patient’s chart.
• Satisfied surgeons and staff. Relationships among pre-op and surgical nurses have improved. We’ve seen significantly fewer case delays and believe it’s helped patient satisfaction. The atmosphere of the pre-op area is much calmer. Even the surgeons have noticed and appreciate the benefits of the new system, because they always know exactly where their patients will be in pre-op, which cuts down on the time they used to spend between cases searching for the next surgical site to sign.

Effectively easy
The changes we made cut down on patient flow congestion and essentially eliminated the Where are they? Who did what? questions that used to waste so much of our time. When I presented this process at this year’s AORN Congress, a nurse told me, “That’s just too simple.” Yes, I said. It is simple — but it works.