Introduction

Unrecognized pre-operative issues and concerns negatively impact operating room utilization and patient safety. The objective of this study is to evaluate the utility of standardized weekly Intradepartmental Conference in detecting pre-operative issues and concerns.

Methods

We implemented a pre-operative conference involving 14 urology staff (4 faculty urologists, 3 residents, 4 physician assistants and 3 nurses) to review operative cases 1 week prior to their scheduled dates. Each case was discussed in detail regarding the condition, procedure, indications, history and physical examination, laboratory and radiological findings, risk factors and social issues. An independent provider who did not directly participate in the conference recorded all concerns and issues as well as all corrective actions and changes. Data was collected in a prospective manner.

Results

Data on 330 cases were collected prospectively over a 12-month period. The operative workload included stone procedures (42%), transurethral resections (32%), open/laparoscopic oncology procedures (10%) and others (15%). American Society of Anesthesiologists (ASA) Physical Status was class 3 in 70% and class 2 in 23%. The majority (88%) of patients had at least 1 medical comorbidity, and 68% (n=225/330) had at least one issue or concern identified during the pre-operative conference; 1 issue (37%), 2 (18%), 3 (10%), 4 (2%) and 5 (2%). Abnormal, missing or pending labs were collectively the most common issue (36%) followed by issues relating to consent (24%), anesthesia and surgical risks (14%), imaging (10%), other work-up (10%), OR resources or equipment (4%), and socio-economical (3%). Such issues required corrective/mitigating actions in 53% (174/330) of cases that related the procedure (18%), pre-operative investigations and optimization including pre-admission (14%) and case order (6%). In addition, 8.7% (29/330) of the cases were cancelled/rescheduled purposefully to allow time to correct the issues. Such practice resulted in improved OR access that allowed earlier dates for 4% of the cases awaiting surgical treatment.

Conclusions

Standardized pre-operative review of surgical cases identifies issues and concerns, and provides an opportunity to implement corrective actions. Such practice has the potential to positively impact OR utilization and patient safety.

Funding

_x000D_ none