Reducing Operating Room Turnover Time For Cataract Surgery, In A High Volume Tertiary Care Hospital In Pakistan- A Quality Improvement Project.

Cataract operations form the highest volume of ophthalmic cases & there is a huge burden of cataract in our population. The aim of this quality improvement project was to decrease the operating room turnover time (TOT) for cataract surgery procedures (local/topical anaesthesia) by at least 30%.

This project was carried out at Aga Khan University Hospital Karachi’s busy surgical day care.

PDSA methodology was used. A team including physicians, OR staff, head nurses & dept chairs was made. Baseline data was collected to assess current state. Process map was made, time was individually measured for each step and feedback collected regarding potential reasons for delay. Data was shared with the team and interventions (backed by evidence from literature) were agreed upon. Next process map+ SOPs with the interventions were tested and monitoring was continued to sustain improvements.

Average TOT of 22 mins was recorded for 15 cases observed over 1 week. 3 interventions were agreed upon by the team:1) additional pre-op waiting area povidone drop step was omitted. 2)proactive role of circulator nurse: prepare unopened equipment packs in advance. 3)Flexibility of roles: Resident primes the phacoemulsification machine simultaneously to help scrub nurse.TOT was measured after implementation of interventions & a significant positive impact with a decrease of 10 mins per case was seen (estimated 90 hrs of OR time/quarter saved).

Our QI project had a substantial positive impact on our OR practice by reducing TOT for cataract surgery by approx. 45% leading to increased output. Both physicians & nursing staff reported improved reliability of care due to standardization & better teamwork.