With healthcare reimbursement increasingly shifting toward value-based models, it's becoming more important for hospitals to engage staff in order to improve outcomes and the patient experience.
These goals are embodied by the tenets of the Quadruple Aim, as outlined in the Annals of Family Medicine. The healthcare performance optimization guideline builds on the Institute for Healthcare Improvement's Triple Aim and places emphasis on reducing per capita healthcare costs, improving both the patient and provider experience, and creating healthier patients by focusing on population health to improve the overall quality of the nation's healthcare system.
To ensure success under the Quadruple Aim, it's imperative for hospital leaders to pay particularly close attention to the operating room and perioperative services. These services — which include admission, anesthesia, surgery and recovery — account for more than 60 percent of revenue among high performing hospitals.
On Nov. 15 at Becker's Hospital Review 6th Annual CEO + CFO Roundtable in Chicago, hospital and health system executives engaged with two leaders from the healthcare consulting firm Surgical Directions in a conversation about the importance of engaging staff, patients and physicians in improving perioperative services.
During the discussion, Jeff Peters, Surgical Directions CEO, and Barry Highsted, RN, director of perioperative nursing with Surgical Directions, offered the executives a detailed outline of how to improve perioperative services. The two leaders offered the findings from a case study involving a Baltimore-area short-term, acute care hospital that experienced a transformation in perioperative services and substantial growth after implementing a set of improvement strategies.
Here are three tips for improving perioperative services.
1. Establish collaborative governance
A critical component of ensuring successful perioperative services is establishing a shared governance structure chaired by a multidisciplinary group of leaders. The governing body should be composed of nurse leaders, surgeons, anesthesiology leadership and senior hospital administrators. This leadership body should be tasked with directing all perioperative team activity.
Meetings held by the leadership group should include staff members from anesthesia, nursing and sterile testing and facilitate discussions on pending action items, recaps of the previous day and a review of scheduling.
"What we've found is this body is able to overcome obstacles that organizations couldn't previously overcome," Mr. Peters said. "Establishing that governance body and then operationalizing it is key to the change."
2. Leverage data analytics for effective scheduling
Scheduling is crucial for success in perioperative services as there are a multitude of moving parts and varying expectations from different members of the care team. Using data analytics to forecast demand and anticipate costs can inform block scheduling in a way that maximizes efficiency and ultimately improves patient outcomes. Data on OR utilization can be used to create heat maps to visualize peak hours and reduce costs associated with under-utilization of ORs, as well as predict admissions to the intensive care unit and efficiently manage beds.
Additionally, this information can be used when communicating the reasoning behind certain block schedules to surgeons and other members of the care team.
A recently retired CMO from the Midwest with nearly 30 years of medical administration experience who partnered with Surgical Directions during his career said he's experienced the communicative benefits of this technique first hand.
"One of the things that was helpful for the medical staff was they didn't really realize how many sites of services anesthesia did as a group," said the former CMO. "They just thought they were in the OR, they didn't realize they were in radiology, interventional, cardiology … so you know when that was all laid out it was very valuable for us."
Mr. Peters added that most EMRs can be easily leveraged to obtain analytics that can help leaders create efficient blocks to maximize output from the most productive surgeons.
3. Improve anesthesia efficiency and reduce case times
As anesthesiology plays a crucial role in successful outcomes and patient satisfaction across surgical specialties, improving efficiency in anesthesia can yield substantial benefits for hospitals and health systems.
"Anesthesiologists are key to driving engagement within perioperative services," Mr. Highsted said. "They're there all the time, so we want them as co-medical directors along with the surgeon. They're the gatekeeper of optimized outcomes … they are very instrumental in the daily huddle."
Mr. Highsted highlighted the importance of allowing anesthesiologists to come together and assemble their own set of protocols they collectively agree to uphold. Anesthesiologists should also play a significant role in developing an organization's pre-anesthesia patient testing policies, which includes risk management strategies, patient scheduling and creating systems to optimize outcomes among patients with multiple comorbidities.
Mr. Highsted also recommended the utilization of anesthesia preference cards in the OR to help reduce case times.
"If different anesthesiologists have different techniques, they like to have the things they need and want for those different types of cases, so we develop [preference cards] as well," Mr. Highsted said.
Other procedural elements shown to successfully reduce case times highlighted during the discussion included ensuring surgeons are in the OR when the patient is first brought in, having physicians assistants set up the OR for complex cases and establishing turnover teams when necessary.
A success in Baltimore
Implementation of the strategies detailed above and other efforts facilitated by Surgical Directions resulted in measurable success at the Baltimore-area hospital cited during the discussion. After executing these strategies, the hospital saw OR turnover time decrease by nearly 50 percent and its surgical volume increase by 23 percent. These changes ultimately resulted in $20 million in additional annual revenue.
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