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Reducing First Start Case Delays Due to Regional Block Placement
EP28803
Reducing First Start Case Delays Due to Regional Block Placement
Submitted on 11 Jul 2018

Jacob Gissy, Stacey Lin, Lauren Meyer, Brendan Atkinson, Thomas Daniel and Matthew Whalin
Emory University Department of Anesthesiology, Atlanta, GA
This poster was presented at Georgia Society of Anesthesiologist Summer Meeting
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Poster Abstract
• Introduction: Many health care systems focus on getting first-start cases in the operating room on time as a key metric of efficiency. Pre-operative placement of regional blocks can be time-consuming, particularly when trainees are performing them. Our quality improvement project sought to reduce delays related to regional block placement for our first start cases at Grady Memorial Hospital in Atlanta.
• Materials and Methods: We generated reports in EPIC to determine the number of first-start patients who received regional blocks, and the number of those cases that had block placement recorded as a reason for delay. We surveyed attending anesthesiologists about barriers to timely block placement and how often they didn’t offer pre-operative blocks for fear of being late to the operating room. Based on feedback from the surveys we devised strategies to attempt to improve efficiency in block placement.
• Results: The period from January to September 2017 was selected as our pre-intervention baseline. As shown in the figure, even during the pre-intervention period there was a trend toward reduced delays. The survey identified communication with surgeons, increased availability of ultrasound machines, and changing morning conference time as potential interventions. In October 2017, we began a more systematic effort to discuss whether patients were block candidates with the surgeons the day before the case. In the first part of 2018 we have had an increase in case volume but the rate of block-related delays has not increased.
• Discussion/Conclusion: Efforts to improve block efficiency and reduce first-case delays are ongoing. Starting in May we are ending our conference five minutes earlier in hopes of providing more time to complete our blocks. We are also working on budget approval for two additional ultrasound machines.

Friedman et al. Increasing operating room efficiency through parallel processing. Annals of Surgery. 2006;243:1

Williams et al. Process analysis in outpatient knee surgery: effects of regional and general anesthesia on anesthesia-controlled time. Anesthesiology. 2000;93:2
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