Presentation Details
| Transforming Perioperative Workflows: Nurse Practitioner Led Anesthesia Preparation to Reduce Delays and Improve Throughput Elizabeth L Kelly, Cheryl Mullan, Joshua Farber-Sault, Maureen Gormley. Boston Children's Hospital, Boston, MA, USA |
Abstract
BACKGROUND: Pediatric perioperative environments require seamless coordination among surgical, anesthesia, and medical/surgical teams to ensure safe, efficient care. Historically, high-risk inpatients and add-on surgical cases at Boston Children’s Hospital experienced delayed optimization and incomplete pre-anesthetic evaluations leading to last-minute cancellations. Limited pre-procedure resources and solo attending coverage often contributed to turnover delays and idle room time. To address these inefficiencies, a dedicated Perioperative Nurse Practitioner (NP) Team was established to perform comprehensive pre-anesthetic preparation, optimize patient readiness, and improve procedural throughput across perioperative locations.
PURPOSE: A phased implementation model recruited experienced NPs with expertise in perioperative assessment, radiology anesthesia coordination, and advanced vascular access. Outpatient Perioperative Care Coordination Clinic (PCCC) guidelines were adapted for the inpatient population, emphasizing early chart review, proactive identification of high-risk conditions, and an electronic flagging system to alert anesthesia teams to complex needs. NPs assumed responsibility for completing all pre-operative tasks before the anesthesia attending arrived, including focused physical examinations, anesthesia consent, optimization review, and premedication administration. Leveraging ultrasound-guided vascular access, NPs established IV access in difficult cases to avoid oral premedication or mask induction. The team further supported solo attendings across the Boston Children’s Hospital enterprise – including main OR, satellite locations, radiology- by maintaining case flow, minimizing room downtime, and ensuring every patient was evaluated by an NP prior to induction.
RESULTS: The team now completes over 700 inpatient pre-anesthesia evaluation (PAEs) each month and proactively assesses over 500 outpatient radiology patients. Early NP involvement has decreased delays between cases, reduced last-minute cancellations, and improved throughput by ensuring patients are fully optimized and prepared before anesthesia arrival.
CONCLUSIONS: Embedding nurse practitioners as perioperative leaders has transformed pre-anesthetic workflow efficiency, procedural readiness, and patient safety. This scalable, replicable model demonstrates the value of NP-led perioperative programs in improving access, coordination, and operational performance within a pediatric tertiary care center
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: A phased implementation model recruited experienced NPs with expertise in perioperative assessment, radiology anesthesia coordination, and advanced vascular access. Outpatient Perioperative Care Coordination Clinic (PCCC) guidelines were adapted for the inpatient population, emphasizing early chart review, proactive identification of high-risk conditions, and an electronic flagging system to alert anesthesia teams to complex needs. NPs assumed responsibility for completing all pre-operative tasks before the anesthesia attending arrived, including focused physical examinations, anesthesia consent, optimization review, and premedication administration. Leveraging ultrasound-guided vascular access, NPs established IV access in difficult cases to avoid oral premedication or mask induction. The team further supported solo attendings across the Boston Children’s Hospital enterprise – including main OR, satellite locations, radiology- by maintaining case flow, minimizing room downtime, and ensuring every patient was evaluated by an NP prior to induction.
RESULTS: The team now completes over 700 inpatient pre-anesthesia evaluation (PAEs) each month and proactively assesses over 500 outpatient radiology patients. Early NP involvement has decreased delays between cases, reduced last-minute cancellations, and improved throughput by ensuring patients are fully optimized and prepared before anesthesia arrival.
CONCLUSIONS: Embedding nurse practitioners as perioperative leaders has transformed pre-anesthetic workflow efficiency, procedural readiness, and patient safety. This scalable, replicable model demonstrates the value of NP-led perioperative programs in improving access, coordination, and operational performance within a pediatric tertiary care center
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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