Introduction: Percutaneous nephrolithotomy (PCNL) allows for a range of instruments within the urologist’s armamentarium. Case-to-case variation creates challenges within the operating room. Appropriate communication can help ensure safe, efficient, and cost-effective patient care. The goal of our study was to first perform a quality assessment of equipment communication. Second, we identified and assessed a target intervention to improve communication and surgical case cost. 

Methods: We administered 45 prospective (30 baseline, 15 post-intervention) questionnaires to multidisciplinary endourology members involved in ≥3 PCNL cases between August 1, 2021, and October 30, 2021. The primary objective was postoperative perception of communication regarding equipment (Likert scale: 1-poor, 10-perfect). A real-time, editable equipment whiteboard was designed and implemented with post-intervention provider surveys. The relative difference in pre- and post-intervention equipment accuracy, as well as overall case costing, was compared 30 days prior to implementation to the period after the intervention. Comparisons used Fisher's exact test (p<0.05). 

Results: Baseline surveys (n=30) were completed (15 registered nurses, eight resident physicians, five surgical techs, two fellows) with an average 2.6 years (range <1–7 years) of PCNL experience. Pre- and postoperative assessment of communication improved after implementation of the whiteboard (preoperative: 6.7 vs. 8.9, p<0.001; postoperative: 7.0 vs. 9.3, p<0.001). On average, 3.2 items (range 2–5) out of five items were accurate on pre-intervention cases. Post-intervention accuracy improved to 4.4 (3–5)/5 items (p=0.049). There was a significant relative case cost improvement after implementing the whiteboard, with an average of $292.50 USD savings per case (p=0.045).    

Conclusions: The development of a real-time, editable PCNL equipment whiteboard improved team perception of equipment communication, case item accuracy, and provided a relatively average cost saving for PCNL at our center.