Problem Statement: Efficient patient throughput is an ongoing challenge in the Interventional Radiology Department. Due to increased healthcare expenditures, it is important to analyze the current patient workflow process to effectively utilize unit resources, reduce inefficiencies, and achieve optimal outcomes (Agarwal et al., 2016). In IR procedures requiring anesthesia, patients are either transferred to the intensive care unit (ICU) or to the phase I post anesthesia care unit (PACU) for their post-procedure recovery and care. All other cases with lesser acuity were transferred to the department’s own phase II PACU recovery room. An increase in the volume of patients undergoing anesthesia caused procedure room holds due to unavailable beds in the ICU or phase I PACU. These holds resulted in delaying procedure start times for subsequent procedures. At the time, IR was only caring for Phase II patients due to staffing and training issues. The purpose of this project was to improve patient throughput, decrease delays in room turnover, and provide patient continuity of care by transitioning the IR phase II PACU to a phase I PACU, thus allowing more of the IR patients to recover in the same department as their procedure.
Process of Implementation: An action plan was developed in November 2016 which included the recruitment and hiring of additional staff, education and training for all staff including technical and ancillary, and reviewing throughput data of anesthesia cases. The use of the American Society of PeriAnesthesia Nurses (ASPAN) and Association of periOperative Registered Nurses (AORN) staffing recommendations and position statements on safe staffing can assist in creating a positive result in decreasing delays in hold times (Fleeger, 2016). Interdisciplinary training through pre-rehearsed clinical situations empowers staff members to have a better understanding of their roles, responsibilities, and mandatory skills needed in an actual emergency clinical situation (Merriel et al., 2016). The training was composed of three integral parts: didactic training, simulation training at the hospital’s simulation center, and shadowing with the phase I PACU nurses. The simulation component included a simulated hands-on review and practice of emergency scenarios that could occur in a phase I PACU.
Findings/Conclusion: The mean total of Interventional Radiology anesthesia cases transferred to the ICU or phase I PACU decreased from 100 % to 54%, resulting in a 46% improvement in patient throughput and fewer delays in procedure start times. Increased staffing and training helped facilitate patient continuity of care by reducing PACU holds in the procedure rooms and increasing throughput. Simulated scenarios helps develop the staff’s critical thinking skills in recognizing early changes in the patient’s condition and begin immediate interventions (Ryan, 2016). High fidelity simulation is valuable to IR nursing practice and education. Collaborative learning, communication, and teamwork through simulation are major influences in work satisfaction (Sharp, 2014). IR nurses reported and demonstrated increased learner satisfaction and activity in providing continuity of care to their patients using simulation.