Quality Improvement Proposal

Quality Improvement Proposal

This paper will provide an overview of a common issue related to the prolonged turnover time that occurs in operating rooms (ORs) across the country. It will also explain why a quality improvement initiative is required to reduce overall average turnover time. This paper will also discuss how previous research supports a quality improvement initiative to help alleviate this issue. Additionally, this paper will discuss the steps necessary to implement a quality improvement initiative in the OR, as well as how the quality improvement initiative will be evaluated. Finally, this paper will identify the variables associated with this quality improvement initiative, test a hypothesis, and provide a statistical test that can be used to demonstrate the success of the quality improvement initiative.

Turnover Time Increase

Turnover time is defined as the time from the “procedure finish” of the previous surgical case to the “procedure start” of the next surgical case. By reducing overall turnover time, the operating room’s throughput should increase, allowing the department to function more efficiently and increasing the hospital’s total revenue.

An extended turnover time can be caused by a variety of factors. A lack of ancillary staff, poorly designed preference cards, a difficult physical layout of the department, and a lack of critical equipment and supplies are some of these factors.

A Quality Improvement Initiative is required.

The Department of Health and Human Services defines quality improvement as “systematic and continuous actions that lead to measurable improvement in health services and the health status of targeted groups” ( Helbig, 2018, para 28). A reduction in turnover time is one of the most important factors in surgical patients’ satisfaction. The turnaround time should strike a balance between ensuring patient safety and increasing efficiency. Although facilities strive for shorter turnaround times, they may incur a higher cost because the process requires additional ancillary personnel.

Providing Support for Previous Research

Prior research has demonstrated the need for and support for models that help reduce turnover times. Majbah Uddin et al. conducted a study that evaluated operating room turnover time using mobile applications. Their study’s goal was to see how well a mobile application developed in collaboration with hospital staff could track and reduce OR turnover time. According to their findings, the mobile application served as both a data collection tool and a visual management tool, facilitating a more expeditious turnover and allowing them to continuously improve the turnover process.

Another study was carried out by six healthcare professionals, ranging from doctors to nurses, to determine if the Elective Change of Surgeon During the OR Day Has an Operationally Negligible Impact on Turnover Time. This study aimed to “compare turnover times for a series of elective cases with surgeons following themselves to turnover times for a series of previously scheduled, elective procedures where the following surgeon differed from the preceding surgeon” (Austin et al., 2014, para 1). Their study concluded that the turnover time for switching surgeons is unquestionably longer than the turnover time for the same surgeon.

A third study, Factors Affecting Hand Surgeon Operating Room Turnover Time, was conducted by eight healthcare professionals as part of the support for a quality improvement proposal. Their study’s goal was to identify factors that contributed to hand surgeon turnover times. Their findings revealed that when the surgeon remained in the OR and participated in the turnover as well as incentivizing the OR staff, turnover time was significantly reduced.

Steps Required for Quality Improvement Initiative

A reduction in overall turnover time can be achieved by applying a few fundamental steps to the turnover process. Participation by all staff members is one of these steps, as is strategically assessing the physical layout of the hospital, centrally locating the ORs inventory, assigning a person to each task performed, and ensuring physician preference cards are updated/accurate. Discussions with anesthesia providers about limiting lunch breaks, promoting surgeon punctuality, and setting a realistic and achievable target goal may also be necessary.

Quality Improvement Initiative Evaluation

Quantitative research is one concrete way to evaluate the quality improvement initiative. Quantitative research is defined as “the process of evaluating numbers and numeric variables to produce measurable data” (Helbig, 2018, para 15). After completing all necessary steps, a decrease in the mean turnover time should be observed. Qualitative research can also be used to assess the efficacy of newly designed steps. A survey can be used to assess the effectiveness of quality improvement by measuring physician satisfaction and patient safety.

Application-Variables in Statistics

Variables are data items that can be measured or counted, such as characteristics, numbers, properties, or quantities. The data item’s value can change or be manipulated from one entity to the next. Variables are classified into three types: dependent, independent, and extraneous (Ambrose, 2018, para 13). Turnover Time is the dependent variable in studies involving OR efficiency and throughput. Ancillary personnel involved, equipment and resource availability such as turnover packs, and the application of recommended practices for systematically cleaning the OR are examples of experimental variables that can be manipulated during this improvement proposal and will have a direct effect on the dependent variable. “A developed system for “room turnover packs” should be created as part of the process for rapid room turnovers. The OR table/bedsheet, the draw sheet, the kick bucket liners, and the various hamper liners should be included in these packs.” Dean (2015) (para 24)

Hypothesis Validation

A well-written hypothesis provides guidelines for carrying out the research. The hypothesis predicts what will happen when the two variables are combined. Both the independent and dependent variables will be identified by the hypothesis (Ambrose, 2018, para 8). Increasing ancillary staff reduces turnover time, according to one hypothesis that can be used during the quality improvement proposal for the OR. To test whether this hypothesis is correct, a link between ancillary staff and the critical role they play during turnovers must be established. “A correlation denotes the mutual relationship or interdependence of two or more things” (Ambrose, 2018, para 9). There is no relationship between increasing ancillary staff and decreasing turnover times, which is a null hypothesis that can help establish the lack of relationship between variables for this proposal.

Statistical Analysis

A statistical test could be used to determine the success of this quality improvement proposal. The experiment would involve a sample of five hospitals, each with at least eight (8) ORs. To ensure accuracy, the hospitals should perform similar surgery types and have the same trauma designation. One hospital will serve as the control for this study by not changing any of its current turnover procedures. Two hospitals will take the necessary steps to reduce turnover, while the remaining two will take only one of the steps listed to reduce turnover times. Turnover time will be defined as the time between when the previous patient left the OR and when the next patient entered. The study should last four months to allow staff to develop a routine with the implementation of turnover time-saving measures. After the four months are up, and the data is analyzed, the overall mean turnover time for hospitals that took some or all of the necessary steps should be lower. Having a high confidence interval for this study should reduce the margin for error.

Conclusion

The purpose and design of quality improvement strategies differ. The Plan-Do-Study-Act (PDSA) cycle is one such strategy. According to June Helbig, “once a problem has been identified, a plan is created to observe the problem and collect data” (plan). After the plan has been made, it is tested on a small sample (do), and the data collected is analyzed (study). After analyzing the data, changes are made based on what was discovered (act)” (Helbig, 2018, para 27). Implementing critical steps is an excellent way to reduce overall turnover time while ensuring the quality improvement proposal is completed.

References

Ambrose, J. (2018). Applied Statistics for Health Care: Clinical Inquiry and Hypothesis Testing. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health- care/v1.1/#/chapter/3

Austin, T. M., Lam, H. V., Shin, N. S., Daily, B. J., Dunn, P. F., & Sandberg, W. S. (2014). Elective change of surgeon during the OR day has an operationally negligible impact on turnover time. Journal of Clinical Anesthesia, 26(5), 343-349. doi:10.1016/j.jclinane.2014.02.008

Dean, A. (2015). 8 Steps to Achieve 7-10 Minute Turnover Times in an ASC. Retrieved from https://www.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/8-steps-to- achieve-7-10-minute-turnover-times-in-an-asc.html

Gottschalk, M. B., Hinds, R. M., Muppavarapu, R. C., Brock, K., Sapienza, A., Paksima, N., . . . Yang, S. S. (2016). Factors Affecting Hand Surgeon Operating Room Turnover Time. Hand, 11(4), 489-494. doi:10.1177/1558944715620795

Helbig, J. (2018). Applied Statistics for Health Care: Statistics Analysis. Retrieved from https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/4

Uddin, M., Allen, R., Huynh, N., Vidal, J. M., Taaffe, K. M., Fredendall, L. D., & Greenstein, J. (2018). Assessing operating room turnover time via the use of the mobile application. MHealth, 4, 12-12. doi:10.21037/health.2018.05.03

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Share your written proposal with your manager, supervisor, or another colleague in a formal leadership position within a healthcare organization.

Complete the “Executive Summary Feedback Form,” located in topic Resources, during the exchange and submit the document.