1. SIP 3 Day of Surgery: After first incision until midnight

2. Process Flow OR PACU Pre-Op Discharge/ Floor Discharge/ Floor Floor/ Check-In ORPACUPre-Op Discharge/ Floor Floor/ Check-In 1 st Patient 2 nd Patient 3 rd Patient

3. Data  An overlap of activities occurs between the current case and the following case, playing a vital role into the continuum of the OR day Patient 1: Patient 2: Close Pt ready to go to OR PAVIP Pt In OR Pt Out OR Call for next patient

4. Data  Average turnover time and prep time vary according to site: Main: 71 min Main Annex: 63 min Pavilion: 48 min Roosevelt: 34 min

5. Issues  Hand-offs of patients and between staff make transitions difficult  The process is not visible and staff do not know if and when critical activities have occurred  Information sharing via paper or verbal does not happen in a timely manner  Changes in plans are not communicated to everyone  Paging or contacting the appropriate staff/faculty is time consuming and difficult  A balance must be made between surgery and education

6. Analysis  Communication plays a major role in all aspects of the process  By reducing the turnover time and prep time, it will allow for maximum amount of OR utilization for patient safety

7. Key Areas of Focus  Communication at Hand-Off  “Briefing”  Turnovers  TBA and Emergent/Urgent Case Management

8. Obstacles  Culture – Everyone must work together as a team to meet a common goal  Culture – Each individual does not need to be efficient as long as the entire system is effective  Political – Each “group” has their own agenda

9. Current Activities  5S Events Equipments (x2) Turnover Prep  RPI’s - Turnover  Team Projects Standardized Report at Hand-off Briefing of the rest of the day