Introduction: Percutaneous nephrolithotomy (PCNL) allows for a wide range of instruments and surgical techniques within the urologist’s armamentarium. Case-to-case variation in instruments can create a challenge within the operating room. Appropriate communication amongst the surgical team can help ensure safe, efficient, and cost-effective patient care. The goal of our study was to first perform a quality assessment of the communication of the surgical equipment required within the endourology team at a high-volume academic center. Second, we identified and assessed a target intervention to improve team communication and surgical case cost.
Methods: We administered 45 prospective (30 baseline, 15 post intervention) questionnaires to multidisciplinary endourology team members involved in =3 PCNL cases between August 1, 2021 – Oct 30, 2021. Respondent role, years of experience and total PCNL case volume was examined along with questionnaire results. Primary objective was assessing postoperative perception of surgical communication regarding equipment (Likert scale: 1-poor, 10-perfect). A real time editable equipment whiteboard intervention was designed and implemented with post-intervention provider surveys completed. The relative difference in pre- and post-intervention surgical equipment accuracy as well as overall case costing was compared from the 30 days prior to implementation to the period after intervention. Comparisons used Fishers-exact test (p < 0.05).
Results: Baseline surveys (N=30) were completed (15 registered nurses, 8 resident physicians, 5 surgical techs, 2 fellows) with an average of 2.6 years (range <1-7 years) of PCNL experience. Pre- and postoperative assessment of equipment communication improved after implementation of the communication whiteboard (Preop: 6.7 vs. 8.9, p<0.001. Postop: 7.0 vs. 9.3, p<0.001). On average 3.2 items (range 2-5) out of 5 items were accurate on pre-intervention cases. Postintervention accuracy improved to 4.4 (3-5)/5 items (p=0.049). There was a significant relative case cost improvement after implementing the PCNL equipment whiteboard with an average of $292.50 USD savings per case (p=0.045).
Conclusions: Our baseline quality assessment of surgical team communication regarding PCNL equipment identified an area for improvement. Multidisciplinary feedback resulted in the development of a real time editable PCNL equipment whiteboard which improved team perception of equipment communication, case item accuracy and resulted in a relative average cost saving for PCNL.