6 insights on boosting operating room efficiency

To optimize performance within operating rooms, hospital leaders can explore numerous ways to ensure their perioperative service lines are positioned for success, such as designing a functional block schedule, adjusting to individual surgeons' needs and encouraging communication between surgical team members.

This article is sponsored by Surgical Directions.

Amy Jerdee, RN, vice president of clinical operations at Green Bay, Wis.-based Aurora BayCare Medical Center, and Jeff Peters, CEO of healthcare consulting firm Surgical Directions, joined 28 healthcare leaders during an executive roundtable at Becker's Hospital Review Health IT + Clinical Leadership conference in Chicago May 10.

Ms. Jerdee discussed how her organization transformed its surgery department, challenges their staff faced and six key strategies hospital leaders used to optimize operating room efficiency.

Balancing surgeons needs with block scheduling

When Aurora BayCare Medical Center, a 167-bed acute care hospital, opened in 2001, the hospital's capacity far exceeded its demand. However, as the hospital's surgical volume grew and more surgeons joined the network, hospital leaders realized they were unable to offer the proper block time that was necessary in the OR, particularly for newer surgeons, Ms. Jerdee said.

The most efficient way to block OR time is to block times by the day rather than use hourly blocks fewer than eight hours. For example, a 12-hour block may work better for specialties that involve longer cases, such as spinal surgery. An extended block permits one specialty or surgeon to utilize the OR for the entire day as opposed to a four-hour block time to handle one procedure.

"We had staff dissatisfaction mostly because we didn't have the right balance between our block times and what our surgeons' needs were," she added. "There was a chaos in our daily operation, where we had variable schedule columns and no team followed the same surgeon. During daily operations, staff didn't necessarily know where they were going or where their next case might be, and it created a lot of inefficiency."

As surgeons became increasingly frustrated with the inefficiencies of the scheduling system and anesthesiologists struggled to cover the hospital's growing number of surgeries, Aurora BayCare leaders looked to implement strategies to improve daily operational processes.

"Our goal is to become one of the best surgical hospitals in the country," Ms. Jerdee said. "With that goal in mind, we had to take a step back and look at how we could improve these processes."

Ms. Jerdee shared six insights on how Aurora BayCare and other hospitals can optimize OR performance.

1. Design a functional block schedule to address the daily chaos of the OR. "We needed to ensure our add-on surgical cases weren't going into the evening and ensure there was enough block time for everyone," Ms. Jerdee said. Aurora BayCare leaders analyzed individual surgeons to determine their block needs and reassigned them according to the appropriate block time. "We met with every surgeon and their groups to determine whether it was a physician schedule or a group block. That was the linchpin and the real change that was significant to our hospital."

2. Examine turnaround times to optimize OR efficiency. "The next piece was about addressing our pre-anesthesia patient optimization process," Ms. Jerdee said. "We hired an internal medicine physician and nurse to open a new clinic to help prepare our patients before their surgery." The hospital then put turnaround teams into action before each procedure to be sure patients were not unnecessarily holding up rooms. 

3. Hold daily, multidisciplinary team huddles. To improve day-to-day efficiency, Aurora BayCare started holding daily huddles, which gives the hospital's OR director, business manager, anesthesiologists, lead nurse and environmental services staff an opportunity to discuss ways to improve daily operations. "We all get together to recap what happened that day and to discuss what could have gone differently or better," Ms. Jerdee said.

"For instance, we review our case schedule to ensure we have anesthesia providers covered and determine whether patients have problems identified before anesthesia that could potentially hold up the surgery," Ms. Jerdee added. "This daily huddle has made a huge difference in how we operate because it recaps our daily operations and is a way for us to keep looking forward."

4. Utilize technology platforms to avoid unnecessary procedures. "We created a dashboard in Epic our staff members can see during the preoperative stage," Ms. Jerdee said. When the entire preoperative and surgical team work off the same, easy-to-read dashboard, providers reduce the chance of duplicative testing and other inefficiencies. "For instance, if a patient needs blood work, we can see if it's already been done and ensure unnecessary tests aren't ordered," she added. Through this system, hospital staff are consistently looking at the same dashboard to see what does or does not need to be completed.

5. Initiate conversations with surgeons on assessing surgical times. One hospital executive at the roundtable asked how to best schedule block times when different surgeons take varying amounts of time to complete the same procedure.

"In most organizations, 80 percent of the surgeons' times are pretty close, but there's always one or two outliers in case time," Mr. Peters said. "To address these outliers, hospital leaders can give surgeons the data and have the chairman of their specialty department sit down with them and compare their times with other surgeons. Try to have a conversation and have that chairman go into the OR to watch that surgeon before privately having a conversation with them about whether they've thought about these things."

6. Encourage staff to openly express concerns through face-to-face conversations. "We won't reach our goal of being the top surgical hospital if staff can't share their concerns," Ms. Jerdee said. "One of the things we found to be prevalent in our hospital is how to manage staff fatigue." For instance, after the hospital began seeing more add-on cases causing staff to work 12-hour days, Aurora BayCare developed a policy to establish discussion around fatigue concerns.

"For anyone who is going to work more than 12 hours, we have a face-to-face discussion, asking whether they feel fatigued and if they need to rest instead of continuing to work," Ms. Jerdee said. "Staff must have the opportunity to say they feel unrested because they often aren't comfortable in voicing that."  

In response to the discussion on encouraging communication between surgical team members, the chief quality officer of a 775-bed hospital in the Northeast mentioned the power of hospital culture in improving operational processes.

"Beyond just working on improving the processes and procedures, both of you mentioned the human factors involved in the daily routines of hospital staff and treating others like human beings — I think that's why you see success," she said.

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