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Decreasing Same-Day Preoperative Delays and Cancellations: A Quality Improvement Project

Abstract A well-run preoperative anesthesia clinic (PAT) is essential to ensure and enhance the delivery of safe and quality care. Deficiencies in multidisciplinary communication between providers (surgery, primary care, anesthesia, PAT nurses, and consultants) affect patient health status preoperatively decreasing quality and safety in the surgical suite. There is a need for the best interventional strategies to avoid increased delays and cancellation rates. Purpose: To identify and define the potential issues causing delays and cancellations in the PAT clinic and create a multidisciplinary team communication and collaboration checklist of preoperative patient status and consulting needs centralized between stakeholders. Method: Utilization of the Plan-Do-Study-Act (PDSA) model for implementing interventions to identify issues in a PAT (pre-anesthesia testing clinic) that increased delays and cancellations. The providers utilized a semi structured questionnaire and interview, an implementation checklist and post implementation questionnaire to identify and correct preoperative issues that increased delays and cancellations. Results: The results showed that increasing communication between the multidisciplinary teams decreased the incidence of preoperative delays and cancellations. Even though the findings can be generalized due to low patient numbers the checklist has the potential to improve workflow throughout the preoperative process. One important theme identified was how communication pathways resulted in improved cohesiveness, reduced fragmentation of care and improved patient assessment preoperatively. Conclusion: Improved workflow and communication between multidisciplinary teams result in improved decision making, improved outcomes and increased quality of care. Consistent education and awareness are needed to reduce communication variability in a PAT clinic for future quality improvement success .