Hospital cuts 30 minutes off ambulatory surgery LOS

Two different units participate in the initiative

The ambulatory surgery department in Glen Cove Hospital, part of the North Shore-Long Island Jewish Health System, has achieved its goal of reducing recovery length of stay from 190 minutes to 160 minutes with the implementation of a Six Sigma initiative and its attendant recommendations. The two-phase project targeted both the post-anesthesia care unit and the ambulatory surgery unit.

"We looked at a number of factors, including type of anesthesia, types of surgery, day of the week the surgery was performed, family availability, and transporter availability, as well as seeing if block booking [doctors tending to book most of their surgeries at a specific time of day] made a difference," says Kathy Albert, RN, MSN, a Six Sigma Black Belt. "We saw that most of the variation was coming from whether the family was available (to take the patient home) or not, whether or not patient needed to void prior to being discharged, and also the discharge criteria."

Preparing for the initiative

The first steps the Six Sigma team took, Albert recalls, involved looking at four other hospitals to benchmark what they were doing. "We wanted to see what their systems were — if they used beepers (to alert family members), had ride criteria, had criteria on fluids before discharge, and if they had a dedicated discharge nurse to get the patient prepared for discharge and evaluated," she explains.

They also conducted a literature search for evidence-based improvement plans, and discovered two important articles about post-op patients' ability to tolerate oral fluids and the necessity of voiding — or lack thereof. "We found it was not necessary to tolerate oral fluids, and also found that voiding was only necessary if the patient received a certain type of anesthesia and also if they had undergone certain types of surgery," Albert says.

Creating scoring system

The program was initiated on Aug. 21, 2006, with changes continuing to be implemented throughout 2007. "We implemented a post-anesthesia discharge scoring system that allowed us to determine if a patient was ready to be discharged," says Albert. "It scored a patient on their activity level, vital signs, nausea and vomiting, and pain and bleeding." The three-point system gives a patient a score of 0, 1, or 2, with 2 being the best score. The team also created the position of dedicated discharge nurse, which did not require an additional FTE. "We also assured that a ride would be available at the time of discharge," Albert says.

As with all new initiatives, there were doubts and questions from the staff. However, says Albert, "One ambulatory surgery nurse really stuck with them. She made sure the patients got moved when they should have been. In the past, patients would just hang out and nap after surgery, but she did not allow that to continue."

[For additional information contact:

Kathy Albert, RN, MSN, Six Sigma Black Belt, North Shore-Long Island Jewish Health System. Phone: (516) 396-6044.]