1. Surgical Improvement Project SIP 2 Data Analysis

3. Key Metrics - Analysis LocationCheck in to Anes Start* (min) Anest Start to In-room (min) In-room to Anes Ready (min) Anes Ready to Incision (min) Main OR98231927 Pavilion84161321 Annex85231523 * Wednesday – late start day, data removed

4. Variation by Service ServiceCheck-in to Incision (min - mean) SD Neurosurg199.425.9 Oto162.67.1 Surg C162.07.2 Orthopedics159.416.6 Gen Surg156.09.6 Gyn145.814.9 Ophthalmology128.64.3

5. Patient Readiness Grid

6. SIP2 Problem Statements RPI5SSIP2JDI Emergent/transplant impact on schedule X Incomplete Patient Orders X Surgeon "in house" requirement = delays X Concentration of case prep between 06:00 & 07:15 X Incomplete documentation X Patient not ready for surgery X Wrong case cart X Late starts due to anesthesia resident availability X Transport delays X Duplication of documentation X Timing of teaching X

7. Patient in Pavilion Pre-OP till HA Pick-up

9. Patient in OR

10. Process Walk-Patient in Holding

11. Process Walk - Patient in OR

12. Summary  Agreement on definitions of times essential.  Billing times do not necessarily indicate work times (ie. Anesthesia start time based on billing time, not actual time)  Data indicates consistency of late starts at all sites.  Greatest delay, and greatest “pain” in the Main OR.  Variation in time (SD) for the different sites, days of week, and overall steps in the process: Check-in to Anest start, Anest start to In-room, In-room to Anest ready, and Anest ready to Incision - are relatively uniform and small, (15-20 min)  Delay and variation analysis by –Service ( –Type of procedure (delay for craniotomy, spine, gastric bypass are outliers) shows some services and types of patients have greater variation and delay  1/2 to 2/3 of time is spent between patient arrival and Anesthesia start.  Mismatch between Preanesthesia Clinic criteria for pt. arrival (based on complexity of patient and amount of preop preparation) and Main OR Transport criteria to the Main OR Preanesthesia area (Gale’s area).  Mismatch between anesthesia staff arrival time and expectations for anesthesia start time.  Anesthesia faculty over committed to start two rooms simultaneously.