Quality Improvement Project to Improve "On-Time Surgical Starts" in a Referral Hospital in Kigali, Rwanda

Monday, 18 November 2019: 2:45 PM

Assumpta Yamuragiye, MHA
Department of Health professional education, Health and rehabilitation sciences program, school of health sciences,, University of Western Ontario, London, ON, Canada

Background: The efficiency of operating room (OR) functions often was affected when the starting of the first procedure scheduled for the day was delayed, causing patients and staff dissatisfaction, inefficient use of resources and potentially deteriorating patients’ conditions.

Purpose of the study: To assess the impact of a quality improvement project on the percentage of surgeries started on time in the hospital.

Study approach: A pre- and post-intervention study was conducted to improve the percentage of first surgeries started on time between March 2016 and March 2017. The intervention was implemented in September 2016, in the University Hospital in Kigali (CHUK), in Rwanda. The hospital has six operating rooms and performed 6706 operations in 2015. All first surgeries scheduled in the study periods were included as study samples. Emergency cases were excluded.

The interventions used; 1) a policy on staff arrival time was developed, 2) an orientation on the policy was provided to all OR staff, 3) regular supervision was conducted by the OR managers. The project was approved by the hospital institution review board ( IRB) and the hospital administration.

Outcome Measures: The percentage of first surgeries “started on time”, the average duration of delay, and the average staff arrival time were measured for the study. Chi square and t-test were used to compare the pre- and post-intervention results using SPSS v.16 with P-value set at 0.05.

Results : The intervention significantly increased the percentage of first surgeries “started on time” from 3% pre-intervention to 25% post-intervention (P <0.001). The average duration of delay was significantly reduced from 86 minutes pre-intervention to 31 minutes post-intervention (P<0.001). The average staff arrival time significantly improved by approximately 30 minutes for all disciplines (P=001).

Limitation of the study and conclusion: Following the eight-step Strategic Problem Solving (SPS) approach, the team was able to identify the cause of the surgery delay due to the late arrival of hospital staff, thus allowing the development of staff arrival time policy, incorporating training and supportive supervision to ensure the policy was operationalized. This project only addresses the issue about staff arrival time but other factors contributing to the delay in starting time of the OR was not addressed. More quality improvement projects using SPS should be conducted. Longer term evaluation should be conducted to evaluate the sustainability

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