The smooth and efficient functioning of operating rooms (ORs) is critical to patient care, patient flow and hospital operations and revenue. However, outdated communication systems, fragmented workflows and underused staff time frequently undermine those goals.
During a May Becker’s Hospital Review webinar sponsored by LeanTaaS, Matthew Tsuei, MD, FACS, president of Central Carolina Surgery and former chair of Cone Health’s iQueue Committee, and Rami Karjian, head of OR business at LeanTaaS, discussed how adopting LeanTaaS’ iQueue for Operating Rooms helped Cone Health (Greensboro, N.C.) enhance communications, streamline workflows and improve resource management. This work allowed the system to gain back 220 daily labor hours and an average of 65 minutes per nurse per shift.
Four key insights were:
- Cone Health faced persistent surgical coordination challenges. As a high-volume health system with five hospitals, 73 ORs and more than 50,000 surgical cases annually, Cone Health operated on the edge of gridlock. Widespread care delays — including delays in surgeries — caused by patient flow bottlenecks had a negative impact on patient and staff satisfaction and financial performance. The organization needed a coordinated system of surgical communications, workflows and block scheduling to introduce efficiencies.
“When I arrived at Cone Health in 2006, OR blocks were drawn out on paper, there was no structure for how new surgeons would obtain blocks and there was no accountability for block utilization,” Dr. Tsuei recalled. He also recounted incremental improvements that Cone Health made, including bringing on board consultants and setting up executive committees. These incremental changes helped operations somewhat, but the organization was still using Excel sheets for OR block scheduling and lacked visibility into real-time utilization data.
“There were multiple stakeholders, multiple pathways of communication that were required to get cases scheduled and if you ever tried to move cases, all of these people had to be contacted again,” Dr. Tsuei said. “So, it became very obvious that we needed something beyond phone calls, emails and monthly Excel reports.”
An additional problem with how Cone Health managed its OR scheduling is that each unit optimized for itself, independent of the other units. Units, managers and individual surgeons were relying on backward-looking dashboards and daily manual huddles, which are unreliable and inefficient tools.
- Capacity optimization systems that balance supply and demand can eliminate gridlock and inefficiencies. The key to these systems’ success is their capability to balance supply and demand for care in real time, thereby maximizing patient throughput.
On the supply side, that means ensuring availability of the right staff — with the right skills, experience and equipment — in the right OR and facility.
On the demand side, it means managing the volume of incoming surgery patients, the type of surgeries they need, the acuities of those surgeries and how long each surgery is expected to last.
Currently, many hospitals struggle to match supply and demand for a host of reasons. Surgeons hold onto OR blocks for too long; there is limited visibility into available OR time; surgeon preferences are misaligned with efficiency; staffing skills and capacity are mismatched to cases; there is fragmented data access and an excess of stakeholders and communication modes.
- AI algorithms that build sophisticated math into automated workflows can help address the supply/demand imbalance. Algorithms such as those that power LeanTaaS’ iQueue for Operating Rooms generate predictions and prescriptive recommendations that can be converted into workflows and actions.
“If it’s not built into the workflow, it’s not going to be successful,” Mr. Karjian said. However, he noted that the introduction of any new technology must be accompanied by effective change management to ensure the technology’s adoption and scalability.
iQueue improves the matching of OR supply and demand by optimizing block allocation through real-time visibility into case progression, case length and OR availability. That information, collected in real time and over time, is used to inform case volume and case duration forecasts up to one month in advance.
“By forecasting these things, health systems can drive throughput and improve case readiness and productivity,” Mr. Karjian said. The iQueue solution uses similar logic to optimize staffing capacity supply and demand.
- Partnering with LeanTaaS enabled Cone Health to replace outdated workflows with a data-driven system. One of the key achievements was gaining data transparency and visibility into OR block scheduling and utilization patterns.
“We searched for a partner who would help us see real-time, believable data that the surgeons would trust and that all stakeholders could access,” Dr. Tsuei said. This capability was crucial for having more productive conversations with surgeons who were not making full use of their block time, yet were reluctant to release this time so others could use it.
“Our goals were also to establish a robust governance system for how blocks were allocated and adjusted, to streamline coordination between office schedulers, nurses, equipment and vendors, and to use our capacity rather than spend millions of dollars building more ORs,” Dr. Tsuei said.
As a result, the organization has improved the timelines of day-of surgeries. By leveraging iQueue’s customized alert system, staff members assigned to a given case receive real-time alerts whenever there is an adjustment to the schedule. This shift led to more than 220 labor hours being saved per day, systemwide, and a 98% reduction in vendor coordination calls. “We’ve used this system extensively with our orthopedics and spine equipment vendors and they love it,” Dr. Tsuei said.
One of iQueue’s newest features, called Real-Time View, also allows managers to see remotely which staff members are assigned to which case and which OR.
“This is the first thing I look at when I walk out of the OR — what’s happening with my next case. And since I manage a big practice, I want to see what our other surgeons are able to get done,” Dr. Tsuei said. “Having the iQueue system with Real-Time View in place has allowed surgeons to become better partners. It squashes all of the arguments that used to happen when someone was perceived to be infringing on [another surgeon’s] OR block territory because everyone sees the same data and it is constantly updated.”
Dr. Tsuei concluded by recognizing Cone Health’s increased revenue as a result of the increase in OR block utilization iQueue has enabled. “The health system is happy with the solution because it drives margin,” he said.
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