Date of Graduation

Summer 8-11-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Cathy Coleman

Second Advisor

Professor David Ainsworth


Problem: Unplanned, inpatient surgical patients were experiencing poor outcomes and dissatisfaction with their overall care. This surgical patient population also lacked communication from their healthcare teams with regard to plans of care throughout their hospital stays.

Context: This was a quality improvement project for the unplanned, inpatient surgical patient population in the Central Valley of California. Approximately 13% of this hospital’s surgical patients required post-surgical care in the inpatient units. These patients, according to unfavorable HCAHPS scores, experienced unsatisfying care and insufficient communication from their healthcare teams, including physicians and nurses.

Intervention: This project implemented an Add-On Communication Tool for the unplanned surgical patients entering the operating room (OR) from the emergency department (ED) or inpatient units. Most importantly, this project reestablished the standard work of completing the pre-op checklist for all surgical patients, which is already part of the patient’s electronic medical record (EMR) in Epic HealthConnect.

Measures: Measures for this quality improvement project included the pre-op checklist completion rate for all add-on, unplanned surgical patients of this hospital, including the use of the Add-On Communication Tool. The outcome measure for this project was improved communication among healthcare professionals and patients, as seen in HCAHPS scores for the unplanned, inpatient surgical patient population.

Results: The pre-op checklist completion project for all unplanned, surgical patients achieved successful results over the last 10 months. Since implementation, completion rates from October 2020 to July 2021 averaged 76%, exceeding the original target of 65% for this timeframe. Additionally, the HCAHPS star rating also increased, from 2.9 stars for the 2020 performance year to 3.6 stars as of June 2021 open data.

Conclusions: This project proved that effective and collaborative communication between healthcare professionals and engaged patients led to better health outcomes following unplanned surgical procedures. Consequently, patients were more satisfied and willing to comply with postoperative care instructions. Moreover, these enhanced interventions shortened hospital stays and expedited post-surgical recoveries.

Keywords: unplanned surgery, pre-op checklist, surgery checklist, surgical checklist, preoperative surgical care, inpatient surgery, surgery HCAHPS