Reducing operating room holds: A multidisciplinary approach

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Lisa Metcalf
Sr. Management Engineer
Lehigh Valley Hospital & Health Network

In response to increasing operating room hold times (holding a patient in the operating room post-procedure due to insufficient capacity in the recovery area), a multidisciplinary team was established to investigate root cause, then design and implement a strategy to reduce hold times by 75 percent. One year after implementation, there has been an average 84 percent reduction in OR hold times, allowing perioperative services to increase surgical volume.

In August 2004, the PACU (Post Anesthesia Care Unit) Lines and Alert project was chartered. The multidisciplinary team included resources from areas impacting the PACU and internal resources from management engineering and organizational development. The PACU Alert objective was to reduce OR holds by 75 percent by designing and implementing an alert system similar to the one implemented by our emergency department to reduce ambulance diversions.

When the team tried to define alert levels using PACU census, we realized there was no correlation between PACU census and OR holds. Further analysis of the OR hold data, gathered using collection tools developed earlier through PACU / management engineering collaboration, revealed multiple root cause factors. Because the PACU must maintain variable nurse / patient staffing ratios, sustainable census of the PACU is more dependent on nurse staffing and patient acuity than on the number of available bays. Using modeling, management engineering was able to provide information to the team illustrating these issues. The position of PACU charge nurse was created to more effectively deploy PACU staff resources and provide a crucial communication link with other departments to coordinate efforts to avoid an OR hold. As a result, one year post-implementation, OR holds have been reduced by 84 percent.