Impact of Organizational Changes on Wait Times in a Pre-admission Testing Unit: A Quality Improvement Project

The Ambulatory Surgical Unit (ASU) at the University Medical Center of El Paso experienced a 10% increase in surgical volume in fiscal year 2023,¹ creating a need to improve efficiency in its Pre-Admission Testing (PAT) department. Staff perceived prolonged wait and interview times, but no baseline data existed to guide decisions. To avoid implementing premature solutions, leadership adopted the Plan-Do-Study-Act (PDSA) model to define the problem, collect relevant data, and test targeted interventions.

A continuous quality improvement project using Plan-Do-Study-Act (PDSA) as a framework.

Two PDSA cycles were conducted. The first cycle focused on identifying variables, obtaining IRB approval, and collecting and analyzing retrospective data from April to August 2024 (n=2712). Key measures included patient wait time, interview duration, total time spent in PAT, monthly volume, and cancellation rates. The second cycle tested two interventions: (1) assigning a dedicated PAT charge nurse and (2) implementing standardized RN-led PAT phone calls using a structured script. Data from September-December 2024 (n=1941) were compared with pre-intervention metrics.

Prior to interventions, patients waited an average of 21 min to be called in, spent 26 min in interviews, and remained in the department for 47-49 min in total. After interventions, all three metrics decreased. Interview wait times declined to 17-21 min, interview durations to 17-20 min, and total time in PAT to 35-42 min. Patients who received structured phone interviews experienced the most significant reductions, although improvements were observed across all groups.

Establishing a dedicated charge nurse and implementing standardized PAT phone calls improved patient flow, reduced interview and wait times, and supported more efficient use of staff resources. The interventions were sustainable over the four-month post-implementation period and demonstrated the value of structured QI methodology in guiding operational improvements. Continued PDSA cycles will be used to refine processes and maintain long-term efficiency gains.