Posted: June 12th, 2022

OR Case – PI indicators, standards, systems thinking

Class Subject: Performance Improvement (Healthcare Information Management)

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 Hospital D is a 400-bed acute-care facility with a wide range of services. Dr. Jones is a cardio-thoracic surgeon at the facility and has been practicing in the area for the past six years. Dr. Jones is performing a coronary bypass procedure on a 59-year-old patient. Although the procedure is going well, it took more time than usual to complete because, prior to beginning, the anesthesiologist needed extra time to ensure a safe experience with the anesthesia due to the patient’s asthma and sleep apnea. The operating rooms at the hospital have been especially busy lately with a high number of unexpected trauma surgeries along with the already busy schedule the operating room tends to have. Dr. Jones is preparing to finish the procedure and “close up” the patient when he notices another physician standing at the window in the door leading into the operating room. The physician is a seasoned physician that has been at the hospital for several decades. The physician not only looks through the window at Dr. Jones, but lifts his arm and taps on his watch as a way to tell Dr. Jones that his surgery time has gone past what is scheduled. Although Dr. Jones is a confident and competent surgeon, this experience really rattles him a little and he finds himself somewhat distracted by the other physician’s behavior. He let himself become a little “short fused” with the staff in the room and begins to speed up his work, pressuring the other staff. Dr. Jones has the patient return to his office with pain and issues in his incision. After further workup, it is determined that a sponge was left in during the procedure. 



  • Identify performance improvement issues based on the description of the issue and provide a brief description. (15 points)
  • Explain the issue based on the systems thinking approach. (15 points)
  • Identify at least 1 indicator that the hospital may use to monitor such issues (surgical errors and alike) along with how that indicator will be measured. (15 points) 
  • Suggest one QI Toolbox technique that may be used to improve the OR processes (flowchart, check sheet, or any other appropriate tools) and explain why that technique would be helpful. (15 points) 
  • Identify the TJC NPSG standard(s) that the hospital OR physicians and staff should be guided by. (complete NPSG is available in the Files area). (10 points) 

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