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Efficiency Improvements of Nonoperating Room Cardiac Anesthesia Services.

OBJECTIVE
Scheduling and staffing nonoperating room anesthesia (NORA) cases often require cross-service coordination and can result in significant delays in patient care, resource inefficiencies, and provider dissatisfaction. The objective of the present study was to reduce these delays and case cancellations for patients requiring cardiac anesthesia for their transesophageal echocardiography procedure.


DESIGN
Preintervention and postintervention analysis of prospectively collected observational data.


SETTING
Single institution, quaternary care hospital.


PARTICIPANTS
Patients requiring cardiac anesthesia for transesophageal echocardiography.


INTERVENTIONS
The study included the following three interventions: outpatient transesophageal echocardiography order screening, identifying the daily NORA cardiac anesthesia attending, and centralizing the scheduling process among all cardiac NORA locations.


MEASUREMENTS AND MAIN RESULTS
Before the interventions, the average delay time for echocardiography laboratory cases was 34.9 minutes (n = 38, standard deviation 30.6). In the two months after the aforementioned interventions were performed, the average delay time was 20.2 minutes (n = 50, standard deviation 10.0), representing a decrease in the wait time of 42%. In the preintervention period, two cases had delays of 60 minutes or more; in the postintervention group, there were zero cases with delays of 60 minutes or more. During the postintervention period, zero cases were rescheduled or cancelled because of lack of availability or scheduling conflicts by the cardiac anesthesia team as opposed to three cases that were rescheduled or cancelled in the preintervention period.


CONCLUSION
In the two months after implementing changes to the scheduling process for NORA cases in the echocardiography laboratory, a substantial reduction in average case delay, elimination of long delays lasting more than one hour, and avoidance of case cancellations were observed.