When you start to work on a project don’t forget to look for quick hits that may make an impact without the need for any detailed process improvement methodology. For example: I’m working on a fairly significant redesign of how our Periop area operates and as we delved into the current process and opportunities we uncovered many small changes that could help the process immediately. One of those changes involved standardizing how we review the Operating Room (OR) and Ambulatory Surgery Unit (ASU) surgical schedules. The daily routine is supposed to involve a daily review of the next day’s surgical schedule. In our situation the two areas are 1700 feet apart yet they both share some limited quantities of very expensive equipment and surgical sets. The daily schedule review is critical because there may be conflicts with surgical set usage, the schedulers may have under or overestimated surgery times, or the Surgeon may have not sent over critical information regarding supplies and sets needed (we often use loaner sets from our vendors). It is also important that the Surgical Nurse Managers and our Sterile Process Supervisor talk about the schedule together as each has a specialized expertise that is needed. A typical problem might be: A surgery scheduled in ASU at 8AM that is using a scope that must be sterilized and sent to the OR for a surgery at 9:30AM; this is a problem because it will take at least 2 hours for the scope to be processed therefore an unrealistic schedule conflict has been created.
While each Surgical Nurse Manager always reviewed the schedule daily, they did not do it at a consistent time, they did not always do it together, and they did not include Sterile Process in the review (although they occasionally called Sterile Process regarding specific problems assuming they remembered and/or did not get distracted). We determined that the three key players must meet every day at 11:30AM to review the schedules together and then note issues on a check list to make sure all problems were addressed before the next day’s surgeries. The results of this simple change have been dramatic: We have eliminated “emergency” scrambles regarding needed surgical sets or equipment (these use to happen at least 3 out of 5 days); the surgeons are noticing that the coordination is cutting their surgical times, and the three departments are developing a camaraderie that was lacking. There is still a lot of project work needed for us to gain significant efficiency gains but these small victories give a boost and provide greater credibility to the larger project efforts.