PROJECT NAME: Day Surgery Patient Satisfaction
Institution: University Of Texas Medical Branch
Primary Author: Emily R. Bryant
Secondary Author: Kathleen L. Denke
Project Category: 4) Efficiency
Overview:
The Day Surgery Patient Satisfaction project was identified based on anecdotal
patient comments about the Day Surgery process. The Day Surgery Unit does not
have patient satisfaction questionnaires, so it was decided a team should be
assembled to gain a better understanding of the patient experience and to analyze
the process. The project aligns with the following organizational goals:
 Promote a culture of high reliability and trust by continuously improving
quality and safety.
 Create and implement transformative clinical delivery systems that advance
patient access and clinical efficiency, strengthen our support systems, and
position UTMB well in a reformed health care environment.
Aim Statement (max points 150):
Increase patient satisfaction regarding DSU wait times from 69% to 76% by June
1, 2012 for all Ophthalmology patients.
Measures of Success:
We measured patient satisfaction through a post-op survey asking the patients
how they rated: the wait time in DSU, explanation regarding wait times and the
overall surgical experience. We also collected actual times from EPIC and
calculated average room turnover time, wait time for all Ophthalmology patients
and wait times of Ophthalmology patients not completely satisfied.
Use of Quality Tools (max points 250):
The team developed a high-level flowchart or value stream map of the Day
Surgery Unit (Figure 1) to gain a big picture view of the process. Next, the team
developed a patient satisfaction survey to identify where the opportunities for
improvement existed. Upon identification that the opportunities for improvement
were on the day of surgery, the team developed a flowchart of the day of surgery
process (Figure 2). The team also developed an Ishikawa diagram to identify the
many possible causes of the longer than planned wait time in the DSU (Figure 3).
Figure 1.
Day of Surgery Flow of Patient
Arrives in
DSU 8th floor
DSU RN
Assessment
Anesthesia
Evaluation
Transported
to OR
Position,
Prep &
Drape
Surgery
Transported
to DSU
Transported
to Holding
2nd floor
Time out
Wake up
Discharged
Home
Figure 2.
Ishikawa Diagram
Figure 3.
OR RN
Preoperative
Checklist
Anesthesia
Induction
Transported
to PACU
Interventions (max points 150 includes points for innovation):
The overall improvement plan was to pilot interventions to improve flow and
mitigate/eliminate the causes of excessive wait time for the Day Surgery patients.
The interventions included:
 Improved process/guidelines for calculating patient arrival times
 Eye stretchers made available in DSU
 Patients transferred directly from OR to DSU
 Created a safe handoff report
 Moved Ophthalmology OR room
 Standardized cataract process for all physicians
 Drug labels created
The team involved was multi-disciplinary including: physicians, DSU nursing, OR
nursing, holding nursing, PACU nursing, and billing. The team communicated the
change to the key stakeholders through educational meetings and posted
standardized process diagrams in the Ophthalmology operating rooms.
Results (max points 250):
The results from the project include:
 Improving patient satisfaction regarding DSU wait time from 69% to 98%,
exceeding our goal of 76% (Figure 4)
 Improving patient satisfaction with communication/explanation of wait time
from 75% to 89% (Figure 4)
 Reducing turnover time for Phacoemulsification procedures in the operating
room from 27 minutes to less than 10 minutes
 Increase in the volume of Ophthalmology cases by 20%
Post-Intervention Patient Satisfaction
Figure 4.
Revenue Enhancement /Cost Avoidance / Generalizability (max
points 200):
As of June 1 2012, Ophthalmology cases increased by 20% (projected 94 cases
per year); which equates to a projected $950,000 in additional charges and
$321,000 in reimbursements for Ophthalmology cases. The other returns on
investments are increased return visits, increased referrals and an improved image
for UTMB.
Conclusions and Next Steps:
The next steps for this project are to identify interventions that can be spread to
other services, communicate recommendations to key stakeholders, and to
implement applicable interventions across all services.