Clinical audit of nonoperative anaesthesia time and surgical site infections of canine tibial plateau osteotomy procedures

Aims and objectives: The aim of this clinical audit was to reduce nonoperative anaesthesia time from 131 minutes to 102 minutes while maintaining surgical site infection rates below 10% for canine tibial plateau osteotomy procedures. Data collected from anaesthesia records and electronic medical records provided the data to measure these aims. Background: Increased anaesthesia time increases the risk for perianaesthetic complications including surgical site infections. Through anaesthesia record analysis we recognised that nonoperative anaesthesia time was a variable that could be targeted for improvement. Nonoperative anaesthesia time is defined as total anaesthetic time minus surgical time. Methods: Review of 40 total anaesthetic records (24 initial audit, 16 re-audit) and electronic medical records provided the data we recorded to determine anaesthesia time information and surgical site infection information. Manual audits were conducted to create a value stream map and nonoperative anaesthesia times were analysed for special cause variation utilising statistical process control. Results: Nonoperative anaesthesia time was 131 minutes, roughly half of total anaesthesia time (270 minutes), while surgical site infection rate was 8.3%. Implementation of changes (team discussion & changes made): A new communication protocol was trialed between anaesthesia and surgical teams. Re-audit: The same procedure and analysis were used for the initial audit and re-audit. During the re-audit nonoperative anesthesia time was reduced to 109 minutes and surgical site infection rate was 6.3%. Application: The communication protocol trialed during the re-audit is still in practice. This audit can be applied to other practices looking to better analyse their anaesthetic time variables and to re-evaluate communication procedures for better patient outcomes.