Regional Block Coordinator Role Introductions Getting Patients there on time Leanne Davis, BSN, RN, CPAN & Alicia White BSN, RN, CAPA

University of Virginia Outpatient Surgery Center Thirty to seventy-five patients each day From two to twenty-seven blocks performed in pre-op Up to seven first-start blocks Anesthesia team consists of one resident, one or two fellows, and multiple attending anesthesiologists Five designated block rooms in pre-op Rescue blocks done in PACU on occasion

Benefits of the Regional Block Improved postoperative analgesia Decreased need for postoperative opioids Fewer adverse effects in comparison to IV narcotic treatment Facilitates early physical therapy and rehabilitation Decreased length of stay Decreased risk of chronic pain

Why Preoperatively? Patient safety Better utilization of turnover time Block as primary anesthetic

The Downside of Pre-op Blocks Delays in the patient getting into the O.R. Decreased productivity Increase in O.R. cases running late “Domino effect” on staffing Decreased patient and staff satisfaction Increased costs

Prior State Little communication between regional block team and nursing Uncertainty on nurse’s and anesthesiologist’s part of which patients would get blocks Surgeons had no concrete point of contact Blocks happening all over pre-op First-case on-time starts for blocks at 36%

How Could We Make This Better?? Designate one FTE to be full-time regional block coordinator Started in April 2017 Works in conjunction with pre-op & OR charge nurses Closely communicates with nursing, anesthesia, and surgery

Starting the Improvement Process Observation and documentation Delay reasons Suggestions for improvement Weekly huddles with nursing and physician leadership, administration, and our Be Safe coach Implementation of visual management boards Spreading the word

A typical block day in OPSC Tracking delays in real time A typical block day in OPSC

Current State Block coordinator sorts out who needs a block the afternoon prior Pre-op nurses assigned to block team depending upon how many blocks scheduled & timing of blocks Block coordinator acts as “ground traffic control” prioritizing blocks Changes are communicated by the surgeons and anesthesiologists to block coordinator who adjusts schedule appropriately All block equipment and supplies are responsibility of block coordinator First-case on-time starts sustained >70% for over a year!

Tips & Tricks for Multidisciplinary Practice Change Attitude and approach are everything Be flexible! Servant leadership Whatever it takes to keep things moving Here to help, not to dictate Focus on the team

What did we Improve? FCOTS from 36% to sustained >70% Communication Collaboration Patient Safety Patient Satisfaction Staff Satisfaction

Where We’ve Been and Where We’re Going! VSPAN 2018, VA Beach, VA UVA’s “Situation Room” UVA 2018 Evidence Based Practice Symposium ASPAN 2019, Nashville, TN VSPAN 2019, Staunton, VA

Teamwork Makes the Dream Work!

Questions?