Protocol Assignment Forum: Program Evaluation

1. Considering the protocol you are developing: identify the process and outcome indicators associated with the program and briefly describe an approach to measuring each.

Process indicators:

• Interventions
  • Review and update of surgeon preference cards and case carts
    • Did all preference cards/case carts get updated?
    • Patients having IVs placed by preop nurses before anesthesia evaluation
      • Time from patient arrival in preop to IV placement
      • % of IVs placed by anesthesia
    • Change in case scheduling: schedule shorter cases first, schedule similar cases back-to-back, determine a daily maximum complexity in the OR and rate each case in terms of complexity of set-up
    • Requiring informed consent to be obtained in clinic so that surgical consent on the day of surgery is not required
      • % of cases with consent in clinic
    • Setting up OR equipment during induction or during room cleanup
    • Allowing housekeeping to start cleaning once dressing has been placed
      • Time from dressing placed to housekeeping in the room
    • Pre-op nursing evaluation negates need for operative nurse evaluation in preop
    • Anesthesia evaluation of next patient during ongoing case
      • % of time anesthesia eval is done during previous case
    • Case carts brought to sub-sterile area before room cleanup
  • Intermediate outcomes – Time intervals can be measured both before intervention and at regular intervals during intervention:
    • Patient time spent in admitting
    • Patient time spent in preop
    • Total patient time in admitting/preop
    • Time from patient arrival in preop to IV placed
    • Time from patient arrival in preop to surgeon consent & update
    • Time from dressing on to housekeeping in the room
    • Anesthesia time from leaving the OR to talking with the next patient
    • Time spent in case set-up
    • How do we evaluate preference card??
  • Stakeholder meetings – some way to evaluate progress?

Outcome indicators:

• Primary outcome: turnover time – time measurement via CaseView
  • Will need to define which turnover times we are measuring: when the same service follows itself (?), when there is another case in the room to follow
  • Number of scheduled cases in a day/week/month – CaseView
  • Secondary outcomes
    • Wait time for add-on cases in a day/week/month – Apex?
    • % of cases with on-time or early start in a day/week/month – CaseView
    • Patient satisfaction – Press-Ganey scores about patient satisfaction, our own survey about wait times (?)
    • Staff satisfaction – administer surveys before and at regular intervals?

2. Define one or more “intermediate” outcome measures (reflecting changes in environment, organizational culture, systems of care, patient or public behavior, and/or clinician behaviors) that can inform you about the mechanism by which your intervention achieves its downstream effect on health inform you about the acceptability of your intervention

• Complication rates – want to track perioperative complication rates to ensure they do not increase with implementation of our project
• Injury rates – ensure that on the job injury rates do not increase after implementation