PCNL equipment whiteboard shown to improve surgical team communication

A recent study found that the implementation of a real-time editable whiteboard to communicate required percutaneous nephrolithotomy (PCNL) equipment needed for cases led to improved perception of team communication, case item accuracy, and relative average cost savings for PCNL.¹ The findings were published in Urology.

Prior to the whiteboard, surgical staff correctly selected 3.2 out of 5 (64%) items, which rose to 4.4 out of 5 (88%) items after whiteboard implementation.

“Our data indicate that usage of a PCNL equipment whiteboard led to significant improvements in team perception of inter-disciplinary communication and case item selection accuracy. We found that after implementation of the whiteboard, general cost savings of $436.81 USD per PCNL case and $488.22 USD per renal moiety were achieved,” said lead author Jenny N. Guo, MD, in correspondence with Urology Times®. Guo is a urology resident at Northwestern Medicine in Chicago, Illinois.

For the study, investigators developed a PCNL-specific whiteboard that could be easily moved between OR rooms if necessary. The whiteboard was filled out prior to each PCNL case to indicate which items were needed and when to open them.

A quality assessment survey was given before whiteboard implementation (n=25) and after implementation (n=15), with responses assessed on a 10-point scale. The study period focused on the 3 months prior to the PCNL board implementation in comparison with the 3 months after implementation.

Confidence rates that all potential equipment needed would be in the OR and all correct equipment would be opened on average was 6.3 and 6.4, respectively, prior to implementation. These scores rose to 8.5 and 8.1 after implementation. Further, significantly fewer respondents on average indicated that they felt as if they had opened incorrect or excessive items after implementation (2.1) compared with prior to implementation (6.7).

Overall team communication was also improved after whiteboard implementation both pre-operatively (6.7 to 8.9) and post-operatively (7.0 to 9.3) (P < .0001).

Accuracy of correctly selected items showed improvement after whiteboard implementation as well. Prior to the whiteboard, surgical staff correctly selected 3.2 out of 5 (64%) items, which rose to 4.4 out of 5 (88%) items after whiteboard implementation (P = .049).

Improvements in relative case cost were also observed after implementation of the PCNL whiteboard, averaging $488.22 per renal moiety (P = .002) and $436.81 per case (P = .001) over the course of the study.

“We believe that these findings are pertinent as they address the topic of healthcare quality improvement initiatives seeking to improve quality of care and operating room efficiency while minimizing excess costs. These data may motivate other institutions to adapt similar equipment whiteboard techniques to improve team interactions and provide potential cost savings,” concluded Guo.

Reference

1. Guo JN, Lee MS, Dean N, Helon J, Krambeck AE, Assmus MA. Quality improvement of surgical team communication of required percutaneous nephrolithotomy equipment. Urology. [published online ahead of print April 7, 2023.] Accessed April 17, 2023. doi:10.1016/j.urology.2023.03.033.