Maximizing Efficiency: A Quality Improvement Project to Improve Inpatient Flow to the Operating Room

Introduction: Half a million pediatric inpatients undergo surgery each year. At a large, tertiary-care academic pediatric hospital, the time required to transition inpatients from the acute care units to the preoperative zones was lengthy and unreliable, resulting in costly operating room (OR) delays. Methods: In 2024, the perioperative microsystem quality improvement team aimed to improve preoperative efficiency by 10% for nonintensive care unit inpatients undergoing nonemergent surgery in the main hospital ORs. The primary outcome measure was the time from the OR's phone call for the inpatient to completion of preoperative nursing tasks, as documented in the electronic health record. The Institute for Healthcare Improvement model framework guided the work. Multiple Plan-Do-Study-Act cycles aimed to improve communication among acute care unit, OR, and preoperative staff. Data were displayed as statistical process control charts. Results: Mean time from calling for the inpatient to preoperative task completion improved from 48.2 minutes at baseline to 43.7 minutes (4.5 min, 9.3% improvement), with a sustained downward shift of the centerline on statistical process control analysis. After the second intervention, process variability also decreased relative to baseline and persisted after implementation. Conclusions: Multiple Plan-Do-Study-Act cycles focused on inpatient-to-OR readiness led to more than 9% improvement in patient flow, enhanced communication between groups, increased awareness of preoperative preparation tasks, and improved trust in OR readiness signals to the preoperative zones. Further study is needed to determine whether similar interventions would be effective at improving efficiency at other hospitals.