Case Study

Reducing Surgical Case Cancellations: Anesthesia Case Study

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Overview

Sheridan has a passion for continuous improvement. Sheridan focuses on continually improving and standardizing processes based on the input of everyone involved in the work itself. See how a mid-sized, anesthesia group approached high cancellation rates that were causing scheduling conflicts and disruptions in anesthesia service.

The Study

High cancellation rates approaching 20 percent were causing scheduling conflicts and disruptions in service for a mid-sized, South Florida anesthesia group. Inefficiencies in flow of information, wide variance in daily case volumes and daily work processes were contributing to staff member stress.

Preparation

Once the problem was defined and the scope was specified, team members were selected comprising a variety of roles in the surgical and anesthesia units, including nursing, registration, IT and a unit secretary. The chief of anesthesia volunteered to lead the transformation, with the hospital's COO as a co-leader.

Event

A detailed agenda was laid out for team members, showing the format needed to move the department toward its goals. Issues offering the most fruitful opportunities for improvement were identified. These included the general clutter of charts, the possibility of collecting information farther upstream and the reduction of charting errors. Team members openly shared suggestions and the most promising solutions were implemented. Improvements included specified positions for each patient chart, in keeping with its stage of PAT (pre-admission testing), in order to support organization and visual management. Requiring insurance verification at an earlier interval was found to increase quality, reduce cancelations and free up time closer to the day of surgery; 72-hour pre-op requirements were also attached to the existing booking sheet for a similar purpose, all of which now receive quality checks innate to the process.

Results

Three weeks after the Kaizen event, the department averaged chart completion of five days before surgery, an improvement from two days. The team continues to strive for seven days advance completion.

  • Cancellation rate within 24 hours has dropped to 5%
  • Massive waste and rework have been eliminated

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