Last updated 2022-06-30T16:32:48Z

VA Operating Room Preparation Standardization

OR setup is not standard and varies significantly with OR staff. This causes inefficiency and creates frustration and lack of familiarity when staff change multiple times throughout a case. These inefficiencies create unnecessary waste and likely contribute to patient safety events. Standardizing OR setups dramatically decreases this variation and increases efficiency by creating the same setup no matter which staff rotates through or sets up the case. The practice led to 100% decrease in variation and nearly 50% increase in efficiency, thus increasing safety and quality.

Origin:

November 2020, Troy Bowling Campus (Lexington Cooper)

Adoptions:

1 successful, 3 in-progress

Awards and Recognition:

Diffusion of Excellence Promising Practice, VHA Shark Tank Winner

Overview

Problem

We found Operating Room (OR) setup to be highly variable, creating frustration amongst rotating staff. We found a significant lack of standard operating procedure for OR setup leading to 100% variation in OR setup in laparoscopic cholecystectomy. Wide variations also existed in efficiency of the OR setup. We studied this through 9 service lines and results w ... We found Operating Room (OR) setup to be highly variable, creating frustration amongst rotating staff. We found a significant lack of standard operating procedure for OR setup leading to 100% variation in OR setup in laparoscopic cholecystectomy. Wide variations also existed in efficiency of the OR setup. We studied this through 9 service lines and results were similar. Procedures studied at Diffusion sites found similar variability. See more

Solution

By engaging key stakeholders, OR setup was standardized. Variation decreased by 100% and efficiency increased by nearly 50%. We did this by working with OR staff and physicians to create the standardized setup. We photographed this setup and put it on the OR wall where the majority of these surgeries take place. This was replicated with the other service lin ... By engaging key stakeholders, OR setup was standardized. Variation decreased by 100% and efficiency increased by nearly 50%. We did this by working with OR staff and physicians to create the standardized setup. We photographed this setup and put it on the OR wall where the majority of these surgeries take place. This was replicated with the other service lines and Diffusion sites. See more

Results

Variation decreased by 100% and efficiency increased by nearly 50%. Setup time went from 22 minutes to 12 minutes and accuracy increased by 100% in laparoscopic cholecystectomy. Similar results were obtained in other service lines.

Metrics

% variation: decreased from 100% to 0%.
Efficiency: Setup time median 22 minutes (12-35 minutes) before standardization to 12.2 minutes after standardization
If instituted VA wide in only laparoscopic cholecystectomy, this would lead to nearly $2,700,000 and 750 hours saved.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

KY: Troy Bowling Campus (Lexington Cooper)

Started adoption on 11/2020, ended on 04/2022.

FL: Orlando VA Medical Center (Orlando)

Started adoption on 04/2022.

FL: West Palm Beach VA Medical Center (West Palm Beach)

Started adoption on 04/2022.

OH: Cincinnati VA Medical Center (Cincinnati, Ohio)

Started adoption on 04/2022.

There are no unsuccessful adoptions for this innovation.

Multimedia

Images

Efficiency of setup compared pre and post intervention.

Results for standardization of cystoscopy setup

Results for standardization of inguinal hernia repair setup

Implementation

Timeline

3 months

1. Communicate with OR staff regarding standardization benefits

2. Establish OR champion to work with OR staff as project grows

3. Identify high volume surgery

4. Work with OR staff to standardize setup

5. Work with OR physicians to confirm needed supplies, decrease variation where possible.

6. Take picture of setup and display digitally vs physically in correct OR.
Starting at the 4th Month

Identify next surgery and proceed from step 4 above.

Departments

Bariatric surgery
Colon and rectal surgery
Orthopedics
Plastic and reconstructive surgery
Surgery
Surgical oncology
Thoracic surgery
Urology
Vascular surgery

Core Resources

Resource type	Resource description
PEOPLE	OR Manager: Buy-in. OR Staff: buy-in. OR Champion 0.2 FTE: implementation and auditing
PROCESSES	The OR champion would need to learn the concept of standardization. This person should take VA Lean training.
TOOLS	camera and digital display or print physical picture

Support Resources

Resource type	Resource description
PEOPLE	OR Champion: would be able to work with site OR champion to establish project and be available to meet on schedule basis for questions/discussion/assessment as needed
PROCESSES	We would provider our pictures/standardization plan
TOOLS	as above.

Risks and mitigations

Risk	Mitigation
Lack of buy-in	The biggest difficulty is buy-in from staff. The staff must understand the benefits. Currently, many OR scrub technicians are taught how to set up separately and don't see the need for standardization. However, realizing this makes breaks, lunches, and shift changes difficult and realizing the Veteran is the only consistent person in the OR except for the surgeon helps to work toward understanding. Our Veterans deserve safe, consistent, reliable care. All employees want this and when this is understood, appropriate buy-in can be acheived.

Risk

Mitigation

Lack of buy-in

The biggest difficulty is buy-in from staff. The staff must understand the benefits. Currently, many OR scrub technicians are taught how to set up separately and don't see the need for standardization. However, realizing this makes breaks, lunches, and shift changes difficult and realizing the Veteran is the only consistent person in the OR except for the surgeon helps to work toward understanding. Our Veterans deserve safe, consistent, reliable care. All employees want this and when this is understood, appropriate buy-in can be acheived.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

Email

Email VHALEXSTANDARDIZATIONPREP@va.gov with questions about this innovation.

About

Origin story

We noticed frustration among staff and distraction among surgeons when staff changed throughout the day as the OR procedure setup varied widely based upon which staff member set the case up. We also noticed setup times varied widely. We sought to study, understand, and improve this.

Original team

Andrew Harris

Erik Ballert, MD

Chief of Surgery

Melissa Newcomb

Charles Campbell

Randy Johnson

Scrub Technician

Debra Jo Barrett

Chief Nurse, Surgery

Pattie Robbins

Nurse

Sam Kindred

Scrub Technician

Tina Lancaster