Nursing Productivity and Patient Flow

The Challenge

CDHA is accountable to the tax payers of Nova Scotia to ensure tax dollars are being spent appropriately. In recent times, perioperative expenditure has grown exponentially as case volumes and patient acuity have increased. Approximately 28,000 surgical cases are performed per year. With decreasing budgets, solutions are needed to manage the cost of surgical care.

The Capital Health District Health Authority engaged Carpedia to assist with improvements to nursing and support staff productivity, patient flow, and patient service. The project scope included 2 sites (Victoria General Hospital and the Halifax Infirmary) comprised of 31 OR theaters, 12 tertiary surgical services, and 4 litho rooms. Both the HI and VG sites have a pre-admission clinic, Sterile Processing Department and Post Anesthetic Care Unit (PACU) and sterile supply departments.

The Results

After implementing over 60 unique process changes and providing hands-on support to managers and charge nurses for several months, all key operational indicators were improved from their baseline values. Some of the targeted improvements as per the Statement of Work included:

  • 75% reduction in OR/PACU holds.
  • 75% reduction in controllable case cancellation (hospital resource issues i.e. instrumentation / staffing / bed availability etc.).
  • 50% Improvement in OR turnaround times resulting in improved access to care and effective use of resources.
  • 72% Improvement in OR startup times.
  • Modifications to the staffing and organizational structure that optimize the skills of CDHA staff, ensuring the right care providers are performing the right tasks.
  • Standardization of instrumentation.
  • Identification of data sets (metrics) to manage the perioperative environment/develop.
  • Improved surgical experience for the patient.

The project focus was designed to balance the diverse aspirations of the different key stakeholders in a Perioperative environment including administrative, clinical and medical. Significant initiatives were achieved that satisfied each of these group’s collective objectives. A key win for the Surgical staff was alleviation of bottlenecks in the Post Anesthetic Care Unit which delayed surgical cases often leading to cancellations. For the nursing staff, case turnovers were compressed which contributed favorably to timely case starts.

The Client Experience

“. . . We were pleased to see the successes that have been accomplished including; improved on-time starts in the OR’s, improved room utilization, achievement of targeted savings, and many of our process changes being sustained [8 months after the project ended].”

Director, Perioperative Services, Capital District Health Authority

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