3 areas of focus to create a more productive operating room

This content is sponsored by Surgical Directions

It has never been more prudent of a time for hospitals to look into improving the efficiency of their operating rooms. This is due to a number of factors, like reimbursement linked to patient satisfaction scores and the overall demand to do more with less. Improving efficiency in the OR can move the needle on all of those issues and more.

For instance, a more productive OR can result in a significant amount of savings.

"Having a room empty during primetime use is costing hospitals money," says Alecia Torrance, RN, the senior vice president of clinical operations for Surgical Directions — and a significant amount of money at that. When a hospital OR is open and does not have a procedure in progress, every minute is costly. Estimates of cost per minute of an unused OR range from $20 (based on research from Stanford University School of Medicine) to $69 (according to UCSF Health System research).

Secondly, patient satisfaction can be boosted with a more efficient OR. "When patients are not operated on during the time they expect, and they have to wait, it affects their satisfaction," Ms. Torrance explains — so eliminating that problem can make for happier patients and higher HCAHPS scores.

Additionally, surgeons want to work in an OR that runs like a well-oiled machine. "Surgeons, who are your customers, are not going to want to utilize a facility if it's not run efficiently," Ms. Torrance says. If a hospital's OR is notorious for inefficiency, surgeons take their cases elsewhere.

Even though it's hugely beneficial to run an efficient OR, it isn't easy to achieve. Several aspects must change to transform an OR into a productive entity with satisfied customers, patients and staff. Highlighted below are three areas hospitals should hone in on and what they can do to make change.

On-time starts

According to Ms. Torrance, the No. 1 reason recorded in EMRs for a late start to an operation is that the surgeon did not show up on time.

To fix this problem, hospitals need to dive deeper into the issue of why surgeons are not prompt. For instance, surgeons often point out that even if they do show up on time, their patient isn't optimized for surgery, so it can't start on time anyways.

"It's a culture of apathy…they're trained to [show up late] because no one is every ready for them," Ms. Torrance says of surgeons. "They get there early to just sit around and do nothing."

To combat this issue, hospitals should do the following:

Put together a daily huddle. One good step toward eliminating these issues is instituting a daily huddle with OR staff. In the huddle, staff members should run down the equipment and supplies they will need for the next day's surgeries. The surgeon's preference card is pulled and verified, and instrumentations are prepared prior to the day of surgery. Staff can also check that every patient's lab work is up-to-date and patients are optimized for surgery. Planning ahead can help put an end to surprises or conflicts that stall procedures from starting on time.

Make sure staff members arrive on time. Ms. Torrance compares OR start times to airplane takeoffs — if the first flight doesn't take off on time, it can back everything up across the country. Similarly, if the day's first surgery is delayed, subsequent surgeries in that OR will also be delayed.

After those changes are made, "then we need to start holding the surgeons accountable for getting there on time," Ms. Torrance says. These two simple steps will eliminate the common reasons or excuses they previously had to arrive later than scheduled.

Improve turnover time

Another area ripe for improvement when it comes to OR efficiency is cutting down on time in between cases. This is easier said than done, according to Thomas Blasco, MD, medical director of Surgical Directions.

"The hardest thing to do in an OR is improve room turnover time," he says, "because the incentives in an OR are directly conflicting with the need for quick turnovers." For instance, nurses are often not incentivized for speeding up room turnovers. Therefore, open communication with the nursing and anesthesia staff is paramount to truly make a dent in turnover times.

Combined with open and honest communication, Surgical Directions recommends and helps hospitals with two solutions to this issue:

Record actual turnovers. It can be beneficial for hospitals to pull out a camera and actually videotape turnovers, Ms. Torrance says. If leaders are simply asking frontline staff what a turnover entails, they "tell you what their perception is" instead of what might actually be happening. "You have to observe the current process of turnovers," Ms. Torrance urges. "When you tape it, you can see all kinds of things to improve."

Institute parallel processing. Another good practice when it comes to speeding up turnover times is implementing parallel processing. "Most often, everything occurs sequentially," Ms. Torrance says, "but it could occur in parallel and can shorten the duration of turnover time."

Revamp the scheduling system

One of the last strategies for improving productivity in the OR is to have a hospital change how it schedules time with surgeons. "Surgeons are going to work wherever they have the greatest access," Ms. Torrance says. Generally, they are looking for a block schedule, where they have an OR reserved unless they release the time.

While implementing a block schedule is a good start, scheduling must be efficient and organized, and that task should come down to a new committee: the surgical services executive committee. This group would include surgeons, anesthesia representatives, senior hospital leaders and nurses.

After it is formed, the surgical services executive committee would work with the surgeons who use the OR to make sure the block schedule is run as smoothly as possible. For instance, if a surgeon knows he or she is going to be on vacation, they should be encouraged to let the committee know ahead of time so it can free up that block of time for use by another surgeon.

Results

Surgical Directions has the results to prove that this multitier approach to boosting productivity in the OR works. One OR, for instance, went from having 57 percent of first cases start on time to 98 percent of first cases beginning promptly by working with Surgical Directions. Ms. Torrance has also seen turnover time decrease from 47 minutes to 26 minutes and seen same-day surgery cancellations fall from 6 percent to less than 1 percent.

The figures are encouraging and inspiring, and the change behind them is comprehensive and methodical. Hospitals shouldn't just pick and choose strategies to implement if they really want to make change in the OR, according to Ms. Torrance.

"I can't stress this enough. If you don't do the whole package — the governance, block redesign, performance improvement with frontline staff and behavior and expectation changes — it won't work."

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