Case study for Nursing cases

            Bill Nettles, Surgical Services Manager, sat in his office and wondered why his surgeons could not start their first operation of the day on time.   He knew that some morning delays were inevitable, but many seemed preventable.   Moreover, these delays were likely to be very costly both in terms of dollars and in their ripple effect on surgeries scheduled later in the day.   A few days later, he discussed his concerns with Dr. Helen Mirden, Chief of Surgery.  Dr. Mirden agreed and they presented their project entitled "Reduction of First Start Delays and Cancellations in Surgery" to the hospital's quality improvement council.   After going through a project prioritization process the project was approved and a timeline developed.  

As the hospital used the six sigma process to improve quality, it began with the Define phase.   Bill Nettles, Dr. Mirden, and Margaret Jordan (a nurse by training,   six sigma black belt and the project leader) selected a multi-disciplinary team consisting of an orthopedic surgeon, a thoracic surgeon, an anesthesiologist, one nurse anesthetist, two operating room nurses, a holding nurse, a circulator nurse, two pre-operative clinic staff, and two registration staff.   After orientation and training in basic six sigma methodology and tools, the team created the following goal statement:

We aim to increase the number of first start cases wheeled out of Main OR holding by the scheduled start time to a room ready operative suite to 100%.

The team further defined the process by creating a SIPOC Diagram (Figure 1) which outlined the key stakeholders (suppliers and customers) in the process and provided a high level overview of the process (inputs, process, and outcomes) to be improved.

The team next moved to the Measure phase where the team created a value stream map to confirm the current process flow and identified outputs, inputs and process variables that impact the project goals.   The process involved four interrelated people or groups preparing for the surgery:   registration (Figure 2), patient holding (Figure 3), anesthesiologist (Figure 4), and Surgeon (Figure 5). Click here to download a pdf version of the flowcharts.

Figure 2 Registration

Figure 3 Holding Room Flowchart

Figure 4 Anesthesiologist Flowchart

Figure 5 Surgeon Flowchart

The World Health Organization (WHO) has created a surgical safety checklist to reduce errors that can occur in the OR. Take 5 minutes to watch this video to get a sense of the complexities in an OR: World Health Organization (WHO) surgical safety checklist:

Thinking about the video and the WHO checklist and looking at Figures 2, 3, 4 and 5, what are your first impressions? Do there appear to be any redundancies in this system? [Hint: Look closely at Figures 3 and 4. How many times is the patient asked to give consent?] What else do you see? Are these redundancies for patient safety? What about the utility of other models such as the WHO checklist? Looking at Figures 2, 3, 4 and 5, make a list of the number of times when a patient interacts separately with a staff person (clerical, medical, or nursing). Think about the WHO surgical safety checklist. How many separate interactions does the patient have with healthcare providers in that scenario?

Compose a 2-3 page analysis in APA format with a title page, introduction, conclusion and reference page. Cite 1-2 scholarly references beyond your text to support your opinions.

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Due: Sunday, midnight CT

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