Perioperative Systems Acceleration Tool in the Preoperative Period

In the preoperative period the Perioperative Systems Acceleration Tool (PSPAT) needs to orchestrate and monitor the following activities:

• Patient identification

• Diagnostic workup

• Incoming patient medications and allergies;

• Surgery schedule

• Determine staff readiness

Perioperative Process
Fig. 8.3 Perioperative process timeline [30]

• Confirm operating room readiness

• Assure supplies and equipment availability

• Capture data on incoming medical record, capture vitals, inputs/outputs (I/Os), preoperative medications, tests, and scans

• Monitor patient entry into operating room

• Monitor patient readiness

The first two tasks serve to identify the patient and the corresponding diagnoses so to avoid any mistakes. For example, wrong-site surgery makes up 2% of medical error [17]. A surgery scheduling system is used to schedule patient, staff, and operating room. At UMMC, a third of surgeries each day are unscheduled; the scheduling problem is extremely difficult in a surgical setting. There are many moving parts to be coordinated and many unanticipated events.

Supplies and equipment must be prepared before surgery, and the case cart with all items needed must be in the operating room before surgery. Case cart readiness was a major problem at UMMC prior to be ginning this study. A substantial amount of paperwork and lab tests must be gathered an interpreted before surgery. There are many points where delays can be induced in the system. As a result, surgery start times are often late, which has major revenue and cost implications. Process mapping and monitoring of critical points can significantly increase patient throughput.

Monitoring patient entry into the operating room and patient readiness for surgery are critical to successful outcomes, particularly with respect to patient safety. Automated monitoring of positioning and timing of the patient can reduce manual data entry, increase accuracy, and provide analytical data essential to planning for process improvement. However, some important processes need to remain manual. One of the best processes has been established at the Massachusetts General Operating Room of the Future facility, where the surgeon talks with the patient just prior to anesthesia. The patient is asked, without any prompting information, why he or she is there, what procedure is to be performed, and where it is to be preformed. The patient points to the spot and the surgeon confirms it has been marked properly. The attending surgeon then asks the resident surgeon to check the medical records of the patient and confirm that everything the patient just stated is in the record. The patient is then anesthetized and brought into the operating room. Prior to start of the procedure, the attending surgeon repeats to the surgical team exactly why the patient is there and what procedure is to be accomplished. The team is asked if they agree. There is a moment of silence until every person on the team gives indication of assent before the procedure begins. This process is very much like a preflight check when operating a military or commercial aircraft. Careful attention to detailed procedures and cross checks prevents many disasters. Unfortunately, this process is not rigorously followed in most operating rooms.

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