Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting.

Nicola Wolfe,Marie Ward,Martin McNamara,Liby Koshy,Seán Paul Teeling

doi:10.3390/ijerph182212217

Abstract

Clinical documentation is a key safety and quality risk, particularly at transitions of care where there is a higher risk of information being miscommunicated or lost. A surgical operation note (ON) is an essential medicolegal document to ensure continuity of patient care between the surgical operating team and other colleagues, which should be completed immediately following surgery. Incomplete operating surgeon documentation of the ON, in a legible and timely manner, impacts the quality of information available to nurses to deliver post-operative care. In the project site, a private hospital in Dublin, Ireland, the accuracy of completion of the ON across all surgical specialties was 20%. This project sought to improve the accuracy, legibility, and completeness of the ON in the Operating Room. A multidisciplinary team of staff utilised the Lean Six Sigma (LSS) methodology, specifically the Define/Measure/Analyse/Design/Verify (DMADV) framework, to design a new digital process application for documenting the ON. Post-introduction of the new design, 100% of the ONs were completed digitally with a corresponding cost saving of EUR 10,000 annually. The time to complete the ON was reduced by 30% due to the designed digital platform and mandatory fields, ensuring 100% of the document is legible. As a result, this project significantly improved the quality and timely production of the ON within a digital solution. The success of the newly designed ON process demonstrates the effectiveness of the DMADV in establishing a co-designed, value-adding process for post-operative surgical notes.

Highlights

IntroductionThe key component of the patients’ medical record is their clinical documentation.It captures the patient care journey from admission to discharge, including diagnoses, treatment, and resources used during their care. [1,2]
The key component of the patients’ medical record is their clinical documentation.It captures the patient care journey from admission to discharge, including diagnoses, treatment, and resources used during their care. [1,2]
The framework adopted in this project was initially DMAIC (Define-Measure-Analyse-ImproveControl); it was quickly understood that the best improvement would result from utilising a Design for Six Sigma, DMADV (Define-Measure-Analyse-Design-Verify) approach

Summary

Introduction

The key component of the patients’ medical record is their clinical documentation.It captures the patient care journey from admission to discharge, including diagnoses, treatment, and resources used during their care. [1,2]. The key component of the patients’ medical record is their clinical documentation. It captures the patient care journey from admission to discharge, including diagnoses, treatment, and resources used during their care. Incomplete or inaccurate documentation can negatively affect the quality of patients’ care, resulting in delays, errors, longer lengths of stay (LOSs), and missed or incorrect post-discharge patient follow-ups, leading to higher readmission rates and increased costs [1,2]. The Operation Note (often termed the “op note”) is an essential document that records exactly what surgical operation a patient had, key findings during surgery, and what the post-operative instructions for further patient care from the surgeon are for colleagues, and immediately post-op, for the Post-Anaesthesia.

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