The operating room (OR) is an area constantly being pushed to the limits of efficiency, productivity, and clinical excellence. This can lead to continuous cycles of change in both clinical guidance and standards as well as operational workflows.
Research has shown how small interventions, even those that don’t require additional resources, can drive continuous improvement in the OR. Improvements in both the use of the OR and staff satisfaction can be achieved with well-placed interventions.[1]
However, in reality, staff shortages, budget constraints, limitations to accessible data, and time to analyze are all barriers that can make lasting change and adherence difficult to achieve even when there is strong evidence.
Access to Data
Data collection is an important part of the patient picture when it comes to decision making and delivering high quality care. Data includes vital signs and imaging as well as historical information (OR and ICU visits, etc.).
Not only is data collection itself a challenge, access to the right data to drive decision making is difficult. Data analysis and retrieval requires many resources that are costly and time consuming – and even if it is completed – providing this detailed data to clinicians in a timely and sustainable manner has proven to be difficult.
Additionally, many data analysis and retrieval programs and systems tend to provide very complicated patient data reports with a lot of extraneous information, leading to confusion that ultimately impacts any chance of driving change quickly.
Providing clinicians simple access to the relevant data has proven to be a barrier to care in the hospital setting highlighting the need for improvements in data collection and sharing.
It’s been shown that when hospital operational level administrators anesthesiologist administrators can visualize patient and operational information, operating room efficiency and patient safety can improve.[2]
Specific OR Scenarios and Challenges
Lung protective ventilation, low flow anesthesia, and the use of quantitative monitoring when using neuromuscular blocking agents are a few areas that even with strong evidence backing their use in the OR, have been shown to have low adherence as well as slow adoption.
The use of standardization through implementing protocols and ensuring that there are measurements to track protocol adoption and success, are ways to expedite adoption and support clinicians in using best practice.
Lung Protective Ventilation
Lung protective ventilation (LPV) has been shown to help reduce pulmonary complications in the OR3. As a rapidly developing technology, there have been barriers to adherence regarding LPV and PEEP strategies.
Researchers have found when protocols as well as clinical decision support (CDS) tools were used, adherence of LPV is increased. CDS tools were felt to be easy to use and respiratory therapists (RTs) at high-adherence facilities said the tools increased their self-efficacy when applying LPV strategies.[3]
Standardized LPV tools and protocols were also reported to increase responsiveness to patient needs in facilities with high-adherence to LPV practices. It’s important to note the same study reported RTs saying the CDS tool limited their autonomy in low-adhering sites.3
Knowing that a protocol and CDS tool can be perceived as both helpful as well as less than helpful is important to recognize when developing and implementing new protocols. It’s finding the delicate balance in supporting clinicians in their OR tasks versus hindering their progress that is the challenge.
