03:45 PM Abstract No. 58 Reducing delayed first case start time: a quality improvement initiative in an urban level 1 trauma center

Abstract

Allegheny General Hospital is an urban level 1 trauma center in Pittsburgh, PA. The interventional radiology (IR) department is staffed by 7 attendings, with 4 angio suites averaging over 3,000 cases yearly. From 2017-2018, the department of IR identified that the first case of the day was frequently delayed, causing a cascade of negative consequences. Timely initiation of the first case is a critical component of quality care and sets the tone and pace of each day. First case start time (FCST) reflects team preparedness and impacts patient care. The following QI initiative was launched to reduce FCST delays in the department. Interviews with the hospital personnel were conducted to evaluate if delayed FCST was a potential area for improvement. Negative sequelae were found to include: delayed starts for remaining cases; extended hours incurring overtime cost; dissatisfied staff; decreased patient satisfaction. FCST delay causes were identified and operationalized. Using a PDSA QI process, investigators emphasized the pre, intra, and post-procedure communication to minimize delays, operationalize reasons for delays, and manage results. Pre-procedure protocol was developed (eg.calling patients to ensure timely arrival, documenting pre-procedure medication orders, admission orders, and physician required pre-procedure tasks). Analysis demonstrated that delays were caused by: staff and equipment availability; lack of communication among team; accountability for late personnel; changes in patient clinical status, and, patient noncompliance with pre-procedure orders. Significant increase in punctual FCST was found in the department of IR. Prior to the present evaluation, 65% of first cases began on time. Since the QI project, greater than 95% of IR first cases begin on time. Improved patient satisfaction lead to a positive ripple effect throughout the IR department. 1) FCST is a valuable metric for departmental preparedness and quality improvement 2) Reducing delayed first case starts has positive, department-wide implications and simple procedural changes yielded fast results 3) Future projects might investigate effects of FCST delays on hospital revenue generation