Feaster, Sun, Seybold, & Chen

STP IN PEDIATRIC NEUROANESTHESIA

Situation•Turnover Time is too long and variable.•Preliminary data seems to support it.

Average TAT (wheels out-wheels in) neuro core group: 41 min non-neuro group: 72 min

Turnover time is multi-factorial Better processes: Valuestream, RPI, etc Low hanging fruit available Results from creation of “neuro core” group•standardize work flow•more surgeon satisfaction• fewer incidents• faster turnover

Target• Increase efficiency (w/o decreasing quality)•Do two crani’s per day without staying until mn.• Improve patient satisfaction• Improve surgeon satisfaction• Improve anesthesia satisfaction (also increase safety as by-product)

Proposal•Utilize non-licensed personnel•Standardized call for assistance during line placement (20/20/20 rule)•Collect more Turnover data to determine delays•Write up standardize work flow•Fellow elective/concentration in Neuroanes

Action Plan: May•Collecting Data

Mine Cerner for turnover dataKeep weekly Log of delays (sx, equip,

anes)Weekly tally to spot trendsImmediate follow up of unusual issues

•Who: Feaster, Chen, & Claure

Action Plan: June

•Anes tech training process.Define expectation of anes techUse videos and simulation exercises

•Who: Mireles, Chen, and Nursing

Action Plan: July•Create neuroanes elective/concentration for fellows.

Define elective objectives and expectations

Work out logistics rotationFinalize standard work write ups

•Who: Wagner, Seybold, & Furukawa

Action Plan: FutureStandardization of work flow (PPI, remi, lines, eye tape)Amicar and Tranexamic Acid for craniosynostosisCreate TIVA protocol for post-fossa (dex? clonidine?)Training and maintenance of skill for subclavian lines (video)Improve safety and efficiency in IRPost-op surveillance for post-op complications (delirium, OIH, hypertension, delay wakening, etc)

Case review and journal clubNeuroanes lecture seriesInitiate research projectsBecome a national leader in peds neuroanes

•Who: Everyone

the end