Surgical Patient Flow - Term Paper Example

Surgical Patient Flow Operation theatre is an expensive resource and a major determinant of hospital costs. Case delays or cancellations especially on the day of surgery cause serious losses for the operation theatre’s time and resources. When the surgical patient flow management works in a set fashion, the delays and cancellations can be decreased proportionately. This study aims to describe and analyze the flow of surgical patients into the operation theatre at King Faisal Specialist Hospital & Research Centre in Riyadh, Saudi Arabia, and to understand how successful these processes are, on the whole, as well as determine the underlying problems that might cause delays or cancellations for surgical cases. In this descriptive and qualitative study, the data was collected through timings taken in the hospital interviews with the staff by following an elective orthopaedic surgical patient, beginning with the decision to operate followed by the timing in which the surgery was carried out. The main findings were the absence of a system in existence as surgical patient flow management to follow-up the complete patient journey and to synchronize the surgical steps as well as co-ordinate the various pieces of patient information needed. There is duplicity in the system while transferring the patient from the clinic to the case manager, and also in the way of determining the surgical day, which can very easily result in a step being omitted. An Official Translator needs to be appointed in the Operation Theatre to avoid incorrect communication to emit and to maintain patient privacy. It was concluded that action needs to be taken to implement the surgical patient flow management, integrate all the system related surgical patient needs, and to educate the patient about the steps that needed to be done. Acknowledgements This dissertation has required the time and patience of a number of people whom I needed to interview in order to collect my data, and to each one of you whom I wish to keep unnamed at this point in time. I am grateful for your timely contributions. It is important to note the following individuals who have been involved with this project: Dr. Zaid Al-Zaid, Chairman of the Orthopedic Surgery Department at King Faisal Specialist Hospital and Research Centre, who spent many hours patiently and good-humouredly explaining surgical patient flow at KFSH&RC. His role as a Surgeon in the clinic is integral to the training of students. His assistance in the area of decision-making as well as linking valuable professional connections is greatly appreciated. Special thanks must also go to Professor Ruth Boaden, who provided encouragement towards this topic and supplied a great deal of research materials. Furthermore, I remain obliged to Dr Richard Common as his academic supervision and support were priceless. Warm thanks are also extended to Dr. Essam Al-Shail, Medical Director of Operating Management, Abdulaziz Al Bahkaly, Administrative Assistant Coordinator of Academic and Training to Faisal Al-Katheri, for his support in providing all of the documents that were required. 1. INTRODUCTION 1.1 Introduction Patient flow represents the ability of the healthcare system to serve patients quickly and efficiently as they move through different stages of care. When the system works well, patients flow like a river, meaning that each stage is completed with minimal delay (Hall 2006). The aim of this project, is to describe and analyze the flow of surgical patients into the operation theatre; beginning with the decision to operate followed by the timing in which the surgery is carried out. Finally, patient transition from the operating room to the recovery room or intensive care unit (ICU) is an essential aspect of this piece. I shall highlight the entire process and how it is performed as well as the issues relating to this topic at a local hospital (King Faisal Specialist Hospital & Research Centre) in Riyadh, Saudi Arabia. If an individual conducts an extensive survey, one will observe that for all kinds of surgical cases there are a number of extensive procedures that need to be addressed properly as preparations in preoperative, interoperate and postoperative scenarios are discussed. If any of these steps are omitted, the surgical procedure becomes compromised which may result in catastrophic events for the patient‘s health. At King Faisal Specialist Hospital & Research, as is the case with most of the area hospitals, protocol in procedures are conducted extremely efficiently by experienced health care professionals. Each individual employed by the hospital is required to be completely fluent in conducting methods of all procedures prior to their active participation. It is notable however; that there is a lack of clearly documented management systems which adequately describe the entire surgical processes which must take place from the time surgery is prescribed up until the patient discharge. Research Objectives Following are the pertinent research objectives: To describe the surgical patient flow at KFSH&RC. To document the complete management process of a patient undergoing surgery in the operation theatre at KFSH&RC. To develop a workflow diagram in order to establish a clear understanding of the process of current surgical patient flow at KFSH&RC. Importance of the topic This study will ensure for an understanding and documentation of the patients’ flow during the surgical procedure and permit us to understand the operating system at King Faisal Specialist Hospital & Research Centre. Furthermore, it will allow for an understanding of how successful these processes are on the whole. From the point of view of this particular study, the first step which must be taken is to improve services and solve any underlying problems. This study may be used as a guide and reference for the entire staff as it may be very useful for members of the operation theatre. Not only this, it will be a worthy step forward to generating effective future strategies and objectives. Overview of King Faisal Specialist Hospital & Research Centre (KFSH&RC) KFSH&RC is an 894-bed with 400 Consultants, 7786 total employees, and annual patient referral of over 32,000 patients with over half-a-million outpatient visits annually. It is a multi-facility, multi-entity tertiary care hospital and one of the leading healthcare institutions in the Kingdom of Saudi Arabia. Its mission is to provide medical services of highly specialized nature and promote medical research and education programs, including postgraduate education training, as well as continued proactive disease prevention. (KFSH&RC Annual Report 2006). 2. RESEARCH METHODOLOGY 2.1 Introduction to the Research Methodology Researchers have long debated the relative value of qualitative and quantitative inquiries (Patton, 1990). Phenomenological inquiry, or qualitative research, uses an elementary approach that seeks to comprehend phenomena in context-specific settings. Logical positivism, or quantitative research, uses experimental methods and quantitative measures to test hypothetical generalizations. Each represents a fundamentally different inquiry paradigm, and researcher actions are based on the underlying assumptions of each paradigm (Hoepfl 1997). Qualitative research, broadly defined, means “any kind of research which produces findings not arrived at by means of statistical procedures or other means of quantification" (Strauss and Corbin, 1990, p. 17). Where quantitative researchers seek causal determination, prediction, and generalization of findings, qualitative researchers seek illumination, understanding, and extrapolation to similar situations. Qualitative analysis results in a different type of knowledge than does quantitative inquiry (LaPorte 1997). As Key (1997) points out, the descriptive research is used to obtain information concerning the current status of the phenomena to describe ‘what exists’ with respect to variables or conditions in a situation. 2.2 Research Design In this case study, examining the surgical patient flow as well as studying the most appropriate and descriptive qualitative study for individual patients will be addressed. As Drever (2003) points out, interviews give high-quality data as well as provide depth of explanation. In this study, the prime resource of gathering information was through interviewing individuals on a one-on-one basis. All of the interviews were undertaken with a mixture of closed and open ended questions which required semi-structured interviews. The concentration on the factors that constitute inputs to processes are undertaken in each part of surgical patient flow and the same have also been addressed. 2.3 Selecting a sample Due to the limitation of the length of this dissertation, the study focused only on the elective cases that the surgery decision made at the Orthopaedic Clinic, until the case left the Operating Room and became active in the Recovery Room or Intensive Care Unit (ICU). The study follows the regular process without discussing any difficulties which might occur. According to KFSH&RC Annual Report (2006), the Department of Orthopaedic Surgery is an active, dynamic, and energetic department in the KFSH&RC. The statistics of the year 2006 show that 1020 new cases were accepted, 1486 inpatient admissions were completed, 1489 inpatient discharges took place and 1292 operating cases with 12,787 outpatient clinic visits on record. 2.4 Data Collection Methods The interviews which were conducted by following the Orthopaedic surgical patient during their stay at the Department of Orthopaedic Surgery provided extensive insights into this subject. Beginning with the decision to operate, up towards the date of the surgery, the following individuals are involved with the patient’s care; Chairman of the Orthopaedic Department, the Orthopaedic Clinic Charge Nurse, Head of Pre-Anaesthesia Clinic, the Orthopaedic Case Manager, the ENT Case Manager, Supervisor of Admission Office, the Operating Room Scheduler Nurse, C2 Ward Head Nurse, Operating Room Holding Area Team Leader and Orthopaedic Surgery Team Leader. 3. DATA ANALYSIS 3.1 Introduction In this study, the data analysis method is a content analysis to analyze interviews. The data is divided into three parts – input, processes and outcome, for each part. There are a number of factors that constitute inputs to processes. Some of the inputs have been derived from human resources whereas others are electronic and paper-based documentation systems and from sources. Under processes, the study describes the details of managerial steps in each part. In the section allotted for the outcome, the studies showing the final results of all processes conducted in each part. 3.2 Limitations The study was in my country, Saudi Arabia, being quite far away from my university and my academic supervisor. This study required a special trip to collect the primary data, and it was done in a time frame of 5 weeks. It was difficult to communicate with interviewing staff from the UK as there were occasions when clarifications on previously collected data needed to be made. A further limitation encountered was the scope of the project which focused on a single medical specialty – elective surgical case, and the study which followed the case until the time of surgery. This limited time frame however, had always been the expected allotted amount of time, and limited length of the dissertation. It nevertheless prevented comparison with other cases such as emergency cases or day surgery cases. This also precluded the investigation of issues such as staffing levels, which if obtained, would have added useful insights and understanding towards the study. 4. CONCLUSION AND RECOMMENDATIONS The presentation and analysis of the research findings in this study revealed a number of important issues with implications for the surgical patient flow. This chapter will provide a conclusion of the study and will then suggest a number of recommended measures in the light of the study findings for practical action, improvements to surgical patient flow and other necessary protocol additions. 4.1 The Literature Review 4.2 Recommendations Through the research carried out at KFSH&RC, a number of issues came to light which compromised the efficiency of the surgical patient flow. On the basis of these factors, number of recommendations for improvement will be put forward. 4.3 Final Remarks To discover the problem is the most important step that could be taken, synonymous with the need to become proactive towards improvements. The staff or the high management in most cases, are unaware that the problems exist. The target of this study is to highlight and identify the weakness and the problems which may occur during the journey of the surgical patient, to help the staff and high management to remove unnecessary delays, to efficiently undergo handovers for patients who are hospitalized for surgical procedures and so on. Word Count: 2,010 Read More