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Improving patient flow in a regional anaesthesia block room
  1. Brigid Brown1,
  2. Ekta Khemani2,
  3. Cheng Lin1,
  4. Kevin Armstrong1
  1. 1Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre University Hospital, London, Ontario, Canada
  2. 2Quality and Risk Management, Humber River Regional Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Brigid Brown; brigid.brown{at}


University Hospital is a tertiary academic centre in London, Ontario, Canada. A designated space known as the block room (BR) supports a model of care to perform regional anaesthesia prior to entering the resource intense operating room (OR). Stress due to time pressure was reported by BR staff. It was presumed that upstream delays in patient admission, preparation, transportation and in the BR resulted in late OR starts. There was limited data for a patient’s preoperative transit at our institution. A prospective quality improvement project was conceived to understand and address concerns surrounding patient flow. Using Plan–Do–Study–Act (PDSA) methodology, we collected baseline data of patients perioperative transit and performed three PDSA cycles for improvement. We established targets for OR entry time and patient arrival to the BR. We examined communication between the surgical preparation unit, BRandORs, involved stakeholders in decision making and continuously sourced feedback for improvement. Over three incremental rapid PDSA cycles and reaudit of our baseline, we found a statistically significant improvement in patients arriving to the BR 60 min prior to the scheduled OR time from a baseline of 31%–53% (p=0.04) and patient operations commencing on time improved from 52% to 65% (p=0.03). The availability of patients in the BR within 15 min of a decision to have them available reached 98% from a baseline of 69% (p<0.001). As a result of the quality improvement process, we were able to significantly improve the flow of the preoperative patient journey at our institution. With a better understanding of complex preoperative processes, we can strategically intervene and potentially improve efficiency, morale and safety.

  • anaesthesia
  • audit and feedback
  • communication
  • pdsa
  • teamwork

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  • Contributors BB: overall project design, development of the data collection sheet, the creation of the PDSA cycles, facilitator of stakeholder meetings for feedback and discussion and primary manuscript writing. EK: initial project design contributor and manuscript writing. CL: project design contributor, data collection, project statistics, manuscript writing and editing. KA: project supervisor and mentor, originally developed the concept of evaluating patient flow, assistance in facilitating stakeholder meetings and manuscript writing and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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