Editor's note: This article by Tony Mira, president and CEO of Anesthesia Business Consultants, an anesthesia & pain management billing and practice management services company, originally appeared in Anesthesia Business Consultants eAlerts, a free electronic newsletter. Sign-up to receive this newsletter by clicking here.
On-time case starts can make the difference between profitable and unprofitable operating rooms. There are multiple causes for late starts, among them clinical complications, unavailable instruments or supplies, unavailable laboratory reports or other paperwork, delays in room turnover and late arrivals on the part of surgeons, patients, and yes, anesthesiologists and nurse anesthetists.
[While much tardiness occurs before the first case of the day], tardiness may occur throughout the surgical day. An article entitled "Real-Time Surgery Tracking Leads to Better Operating Room Utilization and Turnover, and Earlier Surgery Starts" appears on the federal Agency for Healthcare Quality and Research Health Care Innovations Exchange's website, which AHRQ maintains in order "to promote diffusion and uptake of innovations and tools that have met specific inclusion criteria" without endorsing the innovations. In this study, the Vineland, New Jersey Regional Medical Center methodically implemented and evaluated a computerized real-time system for updating OR physicians and staff on the current status of cases. The system provided immediate identification and notice of delays as they developed so that the clinicians could respond appropriately. Among the observed results were the following:
• Increased utilization of OR capacity: Utilization of ORs (10 main ORs, 1 smaller OR and 3 endoscopy rooms) increased from 70 to 82 percent of capacity, as more surgical cases can now be handled in a given day. The surgical caseload increased by 16 percent from 2007 to 2008.
• Fewer cases started at the end of the day: Because of the greater efficiency facilitated by the OR tracking system, the number of "late" cases (cases performed after 3 p.m., which is the end of the surgical day) decreased from 10 to three per day after introduction of the system.
• Faster room turnover: Before the development of the OR tracking system, approximately 10 percent of cases were not turned over within the target of 20 minutes; currently, that percentage has declined to nearly zero. In addition, the caseload turnover has increased without extending daily work hours.
• Faster pharmaceutical restocking: Pharmacy personnel can now complete the restocking process for all suites in two hours; before using this system, restocking required 2.5 to three hours.
• Improved surgeon satisfaction: Before the implementation of the OR tracking system, surgeon satisfaction ratings were "average"; since implementation, surgeon satisfaction ratings are consistently "above average." (Some of this increase may have been due to a concurrent improvement — 24-hour access to a surgical scheduler.
The OR tracking system reduced surgeons' late arrivals through the following mechanisms:
• Monitoring from the surgeon's office: Surgeons with access to the hospital computer network were able to view the electronic status board from their offices, allowing them to monitor the status of their schedule/room and determine whether their cases would be starting on time or be delayed (and if so, by how long).
• Alerts based on operative time: Each time a surgery was scheduled, the OR scheduling system used historical data to calculate estimated procedure duration based on the average duration for that procedure by that surgeon over the last year. This average expected duration was transmitted to the OR tracking system; if a case extended beyond the expected end time, the status board flashed an alert for that room. This alerted the surgeon and staff that the surgical suite would be occupied longer than anticipated.
There are other measures besides electronic tracking that will decrease late starts and turnover times throughout the day. If the surgeons' own time isn't spent waiting for their patients and rooms, they may make a greater effort to keep from wasting others' time.
Learn more about Anesthesia Business Consultants.
Related Articles on Anesthesia:
6 Goals Every ASC Anesthesia Team Must Maintain
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Missouri, Tennessee Advance Patient Safety Interventional Pain Management Bills
On-time case starts can make the difference between profitable and unprofitable operating rooms. There are multiple causes for late starts, among them clinical complications, unavailable instruments or supplies, unavailable laboratory reports or other paperwork, delays in room turnover and late arrivals on the part of surgeons, patients, and yes, anesthesiologists and nurse anesthetists.
[While much tardiness occurs before the first case of the day], tardiness may occur throughout the surgical day. An article entitled "Real-Time Surgery Tracking Leads to Better Operating Room Utilization and Turnover, and Earlier Surgery Starts" appears on the federal Agency for Healthcare Quality and Research Health Care Innovations Exchange's website, which AHRQ maintains in order "to promote diffusion and uptake of innovations and tools that have met specific inclusion criteria" without endorsing the innovations. In this study, the Vineland, New Jersey Regional Medical Center methodically implemented and evaluated a computerized real-time system for updating OR physicians and staff on the current status of cases. The system provided immediate identification and notice of delays as they developed so that the clinicians could respond appropriately. Among the observed results were the following:
• Increased utilization of OR capacity: Utilization of ORs (10 main ORs, 1 smaller OR and 3 endoscopy rooms) increased from 70 to 82 percent of capacity, as more surgical cases can now be handled in a given day. The surgical caseload increased by 16 percent from 2007 to 2008.
• Fewer cases started at the end of the day: Because of the greater efficiency facilitated by the OR tracking system, the number of "late" cases (cases performed after 3 p.m., which is the end of the surgical day) decreased from 10 to three per day after introduction of the system.
• Faster room turnover: Before the development of the OR tracking system, approximately 10 percent of cases were not turned over within the target of 20 minutes; currently, that percentage has declined to nearly zero. In addition, the caseload turnover has increased without extending daily work hours.
• Faster pharmaceutical restocking: Pharmacy personnel can now complete the restocking process for all suites in two hours; before using this system, restocking required 2.5 to three hours.
• Improved surgeon satisfaction: Before the implementation of the OR tracking system, surgeon satisfaction ratings were "average"; since implementation, surgeon satisfaction ratings are consistently "above average." (Some of this increase may have been due to a concurrent improvement — 24-hour access to a surgical scheduler.
The OR tracking system reduced surgeons' late arrivals through the following mechanisms:
• Monitoring from the surgeon's office: Surgeons with access to the hospital computer network were able to view the electronic status board from their offices, allowing them to monitor the status of their schedule/room and determine whether their cases would be starting on time or be delayed (and if so, by how long).
• Alerts based on operative time: Each time a surgery was scheduled, the OR scheduling system used historical data to calculate estimated procedure duration based on the average duration for that procedure by that surgeon over the last year. This average expected duration was transmitted to the OR tracking system; if a case extended beyond the expected end time, the status board flashed an alert for that room. This alerted the surgeon and staff that the surgical suite would be occupied longer than anticipated.
There are other measures besides electronic tracking that will decrease late starts and turnover times throughout the day. If the surgeons' own time isn't spent waiting for their patients and rooms, they may make a greater effort to keep from wasting others' time.
Learn more about Anesthesia Business Consultants.
Related Articles on Anesthesia:
6 Goals Every ASC Anesthesia Team Must Maintain
Anesthesiologist Appointed to AUA Educational Advisory Board
Missouri, Tennessee Advance Patient Safety Interventional Pain Management Bills