Time is money, especially in the OR.
“ORs roughly make about two-thirds of the overall profit for a hospital,” said Ashley Walsh, MHA, the director of client services at LeanTaaS, a medical software company. “They’re expensive to build. They’re expensive to maintain. But they have a high return on the bottom line of the hospital.”
The options to manage an OR budget are multifaceted, as many OR managers and administrators know, but the returns are huge. “A 1% increase in utilization can yield an OR a minimum—a minimum—of $500,000 in revenue per year based just on time,” Ms. Walsh told OR Management News before speaking at this year’s OR Manager Conference, in Nashville, Tenn.
Timing is key, with various schemes for perfection, juggling staff schedules and time slots. The idea isn’t new, but some nuances and updates can help, according to two presentations at the conference, focusing on staff booking and technology tools to streamline OR schedules.
When Time Overlaps
The first technique discussed has gotten a bit of a bad rap from its alleged misuse (see Boston Globe Spotlight Team report), but overlapping time can be a safe way to have surgeons efficiently manage their time. In this technique, the surgeon is only present for the main part of surgery when their expertise is required and not during prep or emergence periods, which are handled by other team members, such as perioperative nurses or anesthesiologists. That way, the surgeon is able to move on to the next case.
In recent retrospective studies, no difference was found between the outcomes of overlapping and non-overlapping surgeries, including morbidity and mortality (JAMA 2018;153:313-321; J Bone Joint Surg Am 2016;98:1859-1867). But for safety and to keep things running smoothly, there are steps OR administrators need to consider when implementing overlapping surgery, according to presenters Diane Skorupski, MSRN, CNOR, NE-BC, the vice president of surgical services at Tampa General Hospital in Florida, and Ronald Bleday, MD, the chief of colorectal surgery and an associate chair of surgery for quality and safety at Brigham and Women’s Hospital in Boston.
First and foremost, there must be a protocol in place to guide the process, the presenters said, specifically defining the “critical portion” of each type of procedure for which the surgeon must be present. “Hospitals develop policies and procedures regarding overlapping surgeries because you do not want concurrent surgeries,” Ms. Skorupski said. “You do not want those critical portions to overlap.”
It’s also important to define what kind of procedures, patients and surgeons should be involved. Not every surgeon will feel comfortable with overlapping, the presenters said, and not every procedure is suitable, especially long, complicated surgeries. Low-risk patients should be selected as candidates. But even with those stopgaps, complications can arise, Ms. Skorupski said. “You always run the risk that one case is more complex and the surgeon discovers something that’s going to take more time. So you’ve got to coordinate that second room very closely.”
There are red flags to watch for within a team, specifically the “optimistic surgeon” or the “optimistic anesthesiologist,” Dr. Bleday explained. With the first, the surgeon thinks he can work faster than he really does. “The optimistic surgeon thinks he can do a critical portion of a surgery in an hour when everybody knows it’s going to be two hours,” Dr. Bleday said. “So the other patient is sitting in the room asleep and not being operated on.” The optimistic anesthesiologist is similar, Dr. Bleday said, when he induces anesthesia “and the next thing you know, the surgeon goes ‘I’m not ready.’”
But when it’s a well-oiled machine of a team, that communicates effectively, it can pull off overlapping surgeries. “Communication is key to make this work,” Ms. Skorupski said.
Technology as a Tool
Overlapping time won’t fit for every surgical team in every OR. When this is the case, there are new programs on the market that can help streamline whatever block utilization or scheduling technique the department uses.
Scheduling can be a headache, and usage reports can be a lot of numbers that don’t really make sense to how department heads and managers can use them to make a change. “They sit every month in committees and look at what the turnover was, look at this, look at that,” said Ms. Walsh, who was a perioperative business manager for eight years with the University of Colorado. “We call that ‘admiring the problem.’
“The process is in place, the people are in place, but they spend an inordinate amount of time pulling and analyzing data. That’s not a good use of their time,” she said.
To combat this, Ms. Walsh and her colleagues at LeanTaaS—including engineers, mathematicians and hospital managers—have developed software that provides reports sent to users that explain options plainly, showing where one chunk of time can be repurposed or identifying where space is needed. They call the metric “Collectable Time,” and it’s part of the iQueue software package. It’s currently in use at 14 different health systems throughout the United States, from academic institutions like Duke Health in Durham, N.C., to large community systems like OhioHealth in Columbus, Ms. Walsh said.
It’s important to focus on block scheduling systems, Ms. Walsh explained, because while concentrating on cutting time here and there—improving on time starts and optimizing turnovers—is well and good, they’re never going to help add another case to the schedule.
Looking at the full schedule, possibly with an analytic like “Collectable Time,” could be a better way. The bonus is that cutting down on wasted time will not only help your hospital’s bottom line, it will make your patients and staff a whole lot happier.