102.01 Quality Improvement of Surgical Care at a Large Tertiary Public Hospital in Lima, Peru

K. R. Iverson3,4, L. Roa4,7, S. Shu4, M. Wong5, P. Zavala5, C. Graham5, L. Caddell4, S. Rubenstein5, L. Lecca5, S. Leon5, J. Colina6, G. Mody2  2University Of North Carolina At Chapel Hill,Department Of Surgery,Chapel Hill, NC, USA 3University Of California – Davis,Department Of Surgery,Sacramento, CA, USA 4Harvard School Of Medicine,Program In Global Surgery And Social Change,Brookline, MA, USA 5Socios En Salud,Lima, , Peru 6Sergio Bernales Hospital,Lima, , Peru 7University of Alberta,Department Of Obstetrics & Gynecology,Edmonton, EDMONTON, Canada

Introduction:
It is estimated that over 300 million additional surgical procedures are needed worldwide to address the global surgical burden of disease. In resource-limited settings, there is a unique opportunity for using process improvement strategies to address this gap in surgical care. In Lima, Peru, a public tertiary hospital serving a low-income population identified an opportunity for improvement in its surgical department. By implementing organizational changes in the admission process for surgical patients, we aimed to decrease wait times for surgery and increase surgical volume and patient satisfaction for elective general surgery procedures.

Methods:
Baseline data on emergency and elective patient wait times, surgical volume, and patient satisfaction were collected over a  nine-week period using a combination of chart review, operative logbook review, and patient surveys respectively. Focus groups were held with key stakeholders to develop the quality improvement initiative. During the first phase of the intervention, Plan-Do-Study-Act (PDSA) cycles were performed to ensure the waitlist for elective general surgery included only patients with up-to-date clinical information. In the second phase, Lean Six Sigma methodology was used to create and adapt a flow diagram for the admission and scheduling process of elective general surgery patients. After six-months, endline data collection took place and outcomes were compared using a 2-sided t-test and Wilcox rank-sum test.

Results:

At the conclusion of the first phase of the implementation process and 5 PDSA cycles, 95.6% of clinical exam data was appropriately documented for patients on the waitlist for surgery. Mean wait times from admission to operation for elective surgical procedures improved from 4.5 to 3.9 days (p = 0.25) post-intervention. The overall time from admission to discharge for emergency and elective surgical patients improved from 7.5 to 5.8 days (p = 0.04). There was an increase in elective surgical volume from a median of 9 cases per week to 13 cases per week (p = 0.24). There was no significant difference between the overall patient satisfaction scores.

Conclusion:
As a result of our quality improvement intervention, the process for scheduling and admitting patients for elective surgical patients became more efficient. Despite a significant decrease in time from admission to discharge, the change in surgical volume and patient satisfaction were not significant. However, there was a clear trend toward improvement in wait times and surgical volume. Main challenges included gaining buy-in from all participants and disruptions in surgical services from construction and bed shortages.