Why Most ORs Are Set Up For Failure

Approximately 47 percent of hospitals have reduced or redirected OR procedures due to anesthesia staffing issues, according to a Tarrance Group Study conducted for the American Society of Anesthesiologists. A lack of comprehensive anesthesia leadership is setting many hospital ORs back, leading to limited access and increased surgery wait times.

Timothy Dowd, MD, manager partner and CEO of North American Partners in Anesthesia, and Richard Becker, MD, president and CEO of The Brooklyn Hospital Center, recently presented a webinar titled "Maximizing OR Efficiency: Why Most ORs Are Set Up for Failure and What to Do About It." Dr. Dowd and Dr. Becker discussed partnerships between hospitals and anesthesiologists, and how this relationship can increase the efficiency of the OR.

Perioperative leadership
Dr. Dowd began the webinar by noting the average anesthesia group is too small to provide the scale and resources necessary to meet the growing needs of a modern-day OR. "The overall problem is there is no infrastructure or data-driven decision making," says Dr. Dowd. By developing perioperative leadership within the OR, leaders can improve staffing efficiency, implement a robust quality assurance program, ensure appropriate physician assignments and lower costs. Perioperative leaders may also be called chiefs of anesthesia, but a broader title refers to leaders who understand hospital operations and business. Perioperative leaders will provide guidance from pre-op to post-op, communicate and coordinate with nurses, build a strong relationship with surgical staff and act as a catalyst for OR improvement.

Quality assurance program
Nearly 10 years ago, NAPA co-founded the Anesthesia Business Group, a certified patient safety organization by the Department of Health and Human Services , which brings together eleven of the largest anesthesia groups in the country and affiliates to create the largest repository of clinical data in the country. NAPA utilizes this integration of collected data for their proprietary Quality Assurance program as there are 31 different indicators tracked in order to help manage the outcomes and clinical performance of their anesthesiologists and CRNAs. The results are then measured against peers within the institution as well as NAPA and ABG's national benchmarks. This allows the OR to adopt a data-driven process to manage staff and recognize outliers.

Dr. Dowd says this type of data also helps physicians improve their individual practices. "One physician had a post-op nausea and vomiting rate three times that of his peers. He had no idea this was the case," says Dr. Dowd. When alerted of the problem, the physician said he had not been administering anti-nausea drugs because he did not see a difference in patients. Armed with quality assurance program data, the physician improved his performance. "A month later, his rate was exactly the same as all the other physicians in the group," says Dr. Dowd.

Dr. Becker says NAPA's quality assurance program has made a significant impact on The Brooklyn Hospital Center's ORs. "We are a safety net hospital. Our percent of Medicaid patients is about 50 percent. So the challenge for us to develop strong bottom line is significant and the challenge for NAPA was significant. The performance we've seen was dramatic and savings were significant," says Dr. Becker.

Expanding anesthesia services
"There is nothing more expensive in the world than anesthesiologists sitting around waiting to provide services," says Mr. Dowd. "You really want to look for additional services you can provide at the hospital." This will lead to a greater hospital reputation and will draw more patients, along with increased surgeon satisfaction. Additional coverage for labor epidurals, GI cases, acute and chronic pain services add additional revenue.

Reducing day of surgery cancellation rates
Day of surgery cancellations are significant source of dissatisfaction for surgeons and are costly to hospitals. The average DOS cancellation rate ranges from 8-12 percent, according to Dr. Dowd. "The anesthesiologist is not needed, the OR lies empty, and this is completely unnecessary," he says. "Most of the reasons the surgery was cancelled were known or could have been known in advance." The DOS rate of 8-12 percent can be driven down though analysis, such as examining bottlenecks, recovery room efficiencies, hospital schedules and anesthesia requirements.

Learn more about NAPA.

Listen to the webinar and view the presentation (pdf).

Related Articles on OR Efficiency:
5 Strategies to Improve Patient Flow in a Busy Hospital
4 Ways to Save OR Staff Time
6 Tweaks to Improve the Efficiency of Hospital ORs

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