1187 Utilizing Lean Methodology to Optimize Operating Room Efficiency: A Multidisciplinary Process-Mapping Exercise

Abstract

Study Objective Optimizing surgical capacity while maintaining high quality patient care is an ongoing challenge in the operating room, particularly for complex procedures requiring significant resources, such as robotic hysterectomy. Process Mapping is a Quality Improvement (QI) strategy which can identify common barriers to surgical efficiency and quality of care by dividing a process into its individual components and analyzing each step separately. Our aim was to design an ideal-state intraoperative pathway for robotic hysterectomy in order to improve operating room efficiency and minimize case cancellation. Design Surgical care team members were invited to a meeting where process steps were evaluated and suggestions for improvements were identified. Various QI/LEAN methodologies were utilized including affinity diagrams with multi-voting, parallel processing strategies and checklist development. Setting Canadian tertiary-care academic hospital Patients or Participants A “current-state” process map for robotic hysterectomy was developed with input from the intraoperative care team consisting of gynecologists, anesthesiologists and nursing staff Interventions Output from the exercise included the design of a “future-state/ideal-state” process map incorporating proposed multidisciplinary strategies for improved efficiency and plans for subsequent implementation. Measurements and Main Results In the 5 months following introduction of the ideal-state process map, mean surgical case time for robotic hysterectomy decreased by 28 mins (11%) and case cancellation rate decreased by 70%. Mean case time, case cancellation rates and the acceptability of proposed interventions will be analyzed in a recurring fashion as part of a Plan-Do-Study-Act (PDSA) cycle. Conclusion A multi-disciplinary approach to improving operating room efficiency allowed for sharing of responsibility and improved communication between team members. Engagement of all stakeholders is fundamental to ensuring accurate analysis of current process flow and successful deployment of QI strategies. This process mapping exercise can be easily applied to other surgical procedures and expanded for use in surgical teaching and education.