Efficacia ed efficienza dei percorsi chirurgici: analisi organizzativa di un blocco operatorio mediante Root Cause Analysis [Pitch]

[Autom. eng. transl.] INTRODUCTION An operating unit is a complex reality in which various professional figures alternate. Pursuing goals of effectiveness and efficiency is of primary importance but at the same time difficult to implement. In this context, waste of resources and time are a frequent risk and can have a negative impact on the quality of assistance, causing delays, cancellations and reprogramming of procedures. The objective of the study was to carry out an overall evaluation of the operating block of a hospital unit in north-eastern Italy, to highlight the weaknesses and promote an improvement strategy. MATERIALS AND METHODS The evaluation was carried out in three phases: initial process mapping of the work context, qualquantitative analysis of health records and final assessment of critical issues using Root Cause Analysis (RCA). In order to promote change strategies, an improvement project has been set up based on the Plan Do Check Act (PDCA) model. RESULTS Six operative units belong to the operating block: General Surgery, Gynecology and Obstetrics, Ophthalmology, Orthopedics and Traumatology, Urology and Endourology. At the end of the evaluation, the root causes of inefficiency were identified and represented by Ishikawa diagram, divided into four macro areas (1) organization / structure: not optimal distribution of operating sessions with 98% occupancy rate in the morning and only 13% in the afternoon; incomplete acquisition of PACS software; (2) personnel: heterogeneity of technical and IT skills; reduction for reasons of cost containment and increase in psychophysical unsuitability; (3) technologies: lack of an interface between software and insufficient technological investments with respect to the needs of the context; (4) methods: insufficient procedures and internal paths; poor company training offer. In order to solve the problems, two multidisciplinary and multi-professional work tables have been started with two distinct aims (1) implementation of the PACS system promoting the updating of personnel and investments in the acquisition of software and (2) reprogramming of operating rooms through equipment renewal, software implementation, staff redistribution and definition of shared paths. CONCLUSIONS The combined evaluation of the working environment, health documentation and the use of the RCA applied to an organizational context analysis has allowed us to identify the underlying causes of the inefficiency to implement corrective measures of overall reorganization oriented to the improvement. The RCA has proved to be a useful assessment tool that can also be applied to organizational analysis. Further evaluations will allow the finalization of the improvement plan and the verification over time of the effectiveness of the strategies identified and implemented.