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September 2009 Issue

The University Hospital Center for Perioperative Care team includes more than 20 nurses, nurse practitioners and clerical staff. Director Andrew Friedrich, MD (first row, third from left), and University Hospital nurse manager Jacquie Williams (first row, first on left), are shown with members of the team.
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UH Boosts Efficiency of Surgery Experience

By Amanda Harper
Published September 2009

An operating room that runs on schedule—all the time—is gold to hospitals nationwide. Day-to-day reality, however, shows that’s not always an easily attainable goal.

Maintaining an efficient operating room process often serves as a major challenge for large academic-based hospitals like University Hospital that are charged with treating patients with complex medical problems.

But it is also one of the most important business functions for a hospital’s long-term viability.

University Hospital has made a concerted effort in the past year to improve its perioperative care process as part of developing more efficient, effective operating room usage standards.

Under the direction of Andrew Friedrich, MD, University Hos-pital’s Center for Perioperative Care (CPC) has undergone significant changes with the aim of building the infrastructure needed to make a complex system safer and more reliable while improving both patient and physician satisfaction with the surgical care process.

Perioperative care begins when the patient first enters the hospital and ends when he or she is discharged.

According to Friedrich, only about 25 percent of hospitals nationwide have clinics dedicated to managing the preoperative process.

University Hospital’s CPC is the only pre-surgical clinic of its kind in Greater Cincinnati.

“Until recently, we really didn’t have a coordinated approach to perioperative care. Every surgical team had a different approach and therefore every patient experienced a different level of pre-surgery evaluation,” explains Friedrich, who is also an anesthesiologist with UC Health.

“The issue here is that we do a lot of big cases on a lot of sick people, so our system had to be designed to match those unique challenges. Community hospitals doing run-of-the-mill procedures on relatively healthy people wouldn’t need this type of sophisticated perioperative structure.”  

University Hospital knew it had room to improve its perioperative care process: In 2005, an external review showed that only 76 percent of first cases in the day started on time—a full 17 percentage points below the national average.

Experiencing delays this early in the day had the potential to lead to exponential delays for the cases that followed.

Cancellation rates and operating room preparation time between cases were also higher than the national average.

In 2006, the CPC team—which has grown to about 20 nurses, nurse practitioners and clerical staff—implemented a pilot project that provided a standardized, integrated approach to patient evaluation and preparation prior to the day of surgery.

University Hospital nurse manager Jacquie Williams is quick to point out that the system is not a one-size-fits-all solution.

“Our staff works with surgeons in advance of a patient’s case to determine the perioperative care of each patient, then executes a systematic plan to complete any required screenings, tests and paperwork required prior to surgery,” she explains.   

The CPC team expects to complete implementation of the new perioperative care process approach across the health system by the end of the year. Currently, about two-thirds of patients are going through the process.

“A good preoperative clinic should minimize potential risks to a patient before he or she is ever wheeled into the operating room,” adds Friedrich.

“Those risks can come from known underlying diseases or other complicating factors— including family medical history, undiagnosed disease and risks inherent to the surgery itself.  

“Patient care is a team sport—everyone from the surgeons and anesthesiologists to the nurses and clinical support staff needs to be an active participant in guiding the patient through the process and educating them about what to expect after surgery.”  

He notes that the CPC’s true value resides in the ability to blend custom and standardized approaches to care while also coordinating the efforts of all people involved in the care of an individual patient.

By requiring an extensive assessment of the patient’s full medical history into the pre-surgery process, potential issues—such as an undiagnosed disease—can be caught early and treatment can be adjusted accordingly.

This also significantly reduces registration time on the day of surgery.

CPC team members say they are already seeing results.

Surgery check-in time went from an hour of pre-check in paperwork to 15 minutes, giving nurses more time to spend with patients.

Procedure cancellation rates have also dropped from 8 percent to under 1 percent and pre-operative procedure time was lowered from 2.5 hours to less than an hour total.

“The results of the pilot program were impressive, but they only impacted about 15 to 20 percent of our patients so you can imagine the impact a comprehensive program could have across the whole system,” adds Friedrich.

For more information on University Hospital’s Center for Perioperative Care, call (513) 584-3094.

To schedule an appointment with a surgeon of UC Health, call (513) 475-8000 or visit www. 

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