A. Botty Van Den Bruele1, M. Main2, C. L. Leaphart1 1University Of Florida,Department Of Surgery,Jacksonville, FL, USA 2UFHealth Jacksonville,Perioperative Services,Jacksonville, FL, USA
Introduction: Quality Improvement (QI) education and Interdisciplinary teamwork for surgical residents are critical areas of program accreditation and practice management. Yet, surgical curriculum applying quality improvement methodology remains largely undefined. Our residency program incorporates a research-based curriculum for categorical interns with foundational instruction in QI methodology. To expand the curriculum and develop systems-based application of QI methodology, we hypothesized that selection of a clinical problem, first-case delays (FCD) in the OR, would provide QI instruction from an interdisciplinary perspective while addressing educational goals.
Methods: After instruction in fundamentals of research, IRB approval was obtained. Resident identification of FCD for the interdisciplinary study was guided by experienced faculty. Literature searches were used to develop data dictionaries of standardized reasons for case delay. The data dictionary was used for direct observation of patient and team-based readiness for in room start at 715 AM. Cases observed were General or Vascular Surgery cases in which residents were involved. Using QI methodology, Pareto analysis was performed to stratify reasons for delay and was compared to computer-recorded staff entries of reasons for delay. Analytical drill-down using Ishikawa diagrams further stratified contributing factors for case delays, providing additional opportunities to expand QI initiatives.
Results: A total of 27 first case starts were observed, of which 25 (92.6%) failed to start on time. Pareto analysis determined the most common reason for delay to be failure of OR room readiness (56%, n=14) followed by near equivalent delays for transport, patient availability, anesthesiology, or surgical reasons. By contrast, computer recorded entries listed surgical team readiness as the primary cause of delay indicating that efforts to address delays could be impaired if not targeted appropriately. Ishikawa diagrams (Figure) demonstrate the complexity of interdisciplinary team function required to prevent FCD while enhancing understanding of how to address delays.
Conclusion: Using clinical issues to apply QI methodology expands resident education in the science of quality improvement and interdisciplinary teamwork while broadening the resident’s understanding of the healthcare system. Ongoing collaboration of teams using QI methodology can be used to prevent first-case delays and improve teamwork in the OR.
