Improvement of Perioperative Efficiency via Pediatric Preanesthesia Respiratory Risk Training

Abstract

Purpose: This process improvement to the registered nurse (RN) preanesthesia telephone call interview applied an evidence-based bundle of interventions to improve perioperative efficiency. The overarching aim was to decrease RN subjectivity regarding pediatric upper respiratory tract infection (URI) symptoms during the preoperative telephone call family outreach interview to allow for early identification of respiratory illness that could lead to a day of surgery (DOS) cancellation.

Design: The design was an evidence-based process improvement with a pretest post-test design.

Methods: An E-learning module, on pediatric preanesthesia respiratory risk training, was delivered to the RN telephone call staff. An anesthesiology-created pediatric URI algorithm with use of the Current signs and symptoms, Onset, Lung disease, airway Device, Surgery (COLDS) score, a preanesthetic risk score for children with URI symptoms, were used to trigger consultation with anesthesiology for URI symptoms. Anesthesiology consultation cards following situation-background-assessment-recommendation were used to streamline consultation with an anesthesiology attending physician. Predata were obtained from the Quality Report Card on patient illness cancellations made both on the preoperative telephone call and DOS from the previous 24 months. A plan-do-study-act cycle was completed over 10 weeks.

Findings: RNs' confidence in their ability to recognize the need for anesthesiology consultation was 92% after completion of the E-learning module. The rate of DOS cancellations for patient illness decreased by 10% from 2021 and 7% from 2022. The rate of preoperative telephone call-identified patient illness cancellations increased by 10% from 2021 and 7% from 2022. Decreasing DOS cancellations by early identification of illness on the preoperative telephone call is preferred to avoid loss of operating room time, patient and family dissatisfaction with a DOS cancellation, and provide a safer time frame for surgery and anesthesia.

Conclusions: RNs' confidence in anesthesiology consultation protocol was high after completion of the E-learning module. The process improvement to the RN workflow resulted in improved perioperative efficiency as evidenced by comparison of pretest post-test data indicating a reduction in DOS patient illness cancellations and an increase in preoperative telephone call patient illness cancellations.

Keywords: perioperative respiratory adverse events; preanesthesia respiratory risk; preoperative anesthesia interview; preoperative telephone call; surgical cancellations.