Use of Monitoring Worksheet “Scorecards”
BEVERLY A. JOHNSON, RN, BSN, JACQUELINE CAREY, RN, CHRISTINE HANLEY, RN, W. PETER GEIS, MD
Operating rooms are expensive to utilize, equip, and manage. Patients undergoing complex laparoscopic minimally invasive surgery utilize numerous amounts of highly technical equipment and specific disposable supplies. This process often yields costly surgical procedures. Monitoring of all resources used in conjunction with the sequence of surgical procedures has enabled our operating room to decrease inefficiencies, to eliminate waste, and to collect data to improve our patient care and further improve the process. Recording of key performance perspectives using actual start and end times of case setup, including intubation, positioning, the sequence of surgical events, and the use of disposable supplies provides us a collection of data that allows assessment of each sequential event and implementation of improvements in each sequential event.
Our operating room staff actively provides input into case setups. Concerns and issues occurring during the procedure are recorded and discussed, and solutions are initiated. The staff’s knowledge has increased since they actively provide input into case setups with application to all aspects of surgical procedures. This data is discussed at team meetings and provides an avenue for education of the operating room staff. The staff has experienced an empowerment and accepted a broader range of responsibility. Goals for improving case efficiency are set. Collaboration with other surgeons enables team goals to be reviewed and reinforced. Time frames of procedure outcomes are benchmarked.
The scorecards also provide a mechanism to assist with the choreography of the surgical suite. Since the procedures utilize an abundance of equipment, our preprinted forms provide a time efficient tool to eliminate the guesswork from determining the placement of equipment. Case setup time has averaged a 6-7% time decrease since the use of scorecards. Data collection on “resources used” allows critical discussions regarding further improvement to eliminate wasting of supplies.
Finally, collaborating with other surgeons on the importance of procedural monitoring using a scorecard has fostered a relationship with our surgeons, anesthesiologists, and staff that is positive, productive, and rewarding. With the use of scorecards and good teamwork, operating and supply costs were reduced by 7% in 2001.
This paper is a synopsis from the Best Poster Award at Endo Expo in New Orleans, September 2002.
Address reprint requests to: Beverly A. Johnson, RN, Saint Peter’s University Hospital, 254 Easton Ave, New Brunswick, NJ 08901 Telephone: 732 745 8600 ext. 5184, E-mail: [email protected]
The use of scorecards at Saint Peter’s University Hospital, New Brunswick, New Jersey began with the appointment of our current Chairman of Surgery; Director of the Minimally Invasive Skills Learning Center, W. Peter Geis, MD, in July 2000. Beverly A. Johnson, RN, BSN, Perioperative Instructor, Christine Hanley, RN, CNOR, Laparoscopic Team Leader and Jacqueline Carey, RN, CCRN, Director of Perioperative Services, spearheaded with Dr. Geis the identifiers on the scorecards. The goal of the scorecard is to monitor the use of appropriate resources, monitor surgical events, and improve patient outcomes. Figures shown are for a right colon resection: top left, front of worksheet; bottom left, back of worksheet; bottom right, room setup worksheet.
www.Laparoscopy.org The Laparoscopic Surgery Information Source