Feasibility of Standardizing Pre-operative Assessment Clinics Across a Hospital System

Pre-operative assessments, which include patient history and physical examination, are fundamental in ensuring patient education about their procedure, and leads to successful post-operative outcomes. Within Niagara Health (NH), there are three main hospital sites where operations occur. Currently, there is inconsistency in the pre-operative assessments between sites for the same surgical procedures, demonstrated by variation in pre-operative assessment times, activities, and information given to patients.  The aim of this project is to understand where standardization through quality improvement (QI) initiatives should begin within these pre-operative assessment clinics and determine the feasibility of standardization across varying hospital sites. To achieve this aim, Plan, Do, Study, Act (PDSA) cycles were conducted and involved structured observations at each site to gain a comprehensive understanding of pre-operative practices across sites. Root cause analysis found moderate correlation at two sites and strong correlation at one site between patient age and consult time. Affinity analysis determined that the most pragmatic and feasible area for improvement was through standardization of admission history forms. While the piloting of a new standardized form showed no significant increase in consult times, fundamental barriers such as nursing staff turnover, lack of familiarity with the new form, and concerns of comprehensiveness prevented the continuation of this new standardized form. Future attempts at standardization should begin with collaboration and co-design with pre-op clinic staff, followed by identification of elements of the complex adaptive system that can feasibly be standardized to reduce unnecessary variation while at the same time increasing buy-in for form use.