'Doing the fast things fast and the slow things slow' — 7 strategies to improve OR efficiency without compromising safety


Reducing overhead costs and improving patient safety in the operating room aren't mutually exclusive — but finding a balance requires a well-planned strategy.

The importance of patient safety in healthcare cannot be underestimated in the current era of value-based care. Not only is placing an emphasis on patient safety important for improving outcomes, it also demonstrates clinical quality and boosts morale among employees.

However, under mounting financial pressures, hospital administrators have rightfully placed a heavy concern on efficiency in recent years. As the OR is one of the costliest service lines in a hospital, it presents the greatest opportunity for cutting costs and reducing operational waste. With these considerations, the crucial question becomes: How can hospitals reduce OR costs while maintaining an emphasis on safety?

During a July 13 webinar, Adam Blomberg, MD, Chief of Anesthesiology at Memorial Regional Hospital in Hollywood, FL., and the National Education Director for Anesthesia Services at Envision Physician Services, discussed how hospitals can achieve this critical balance between safety and efficiency.

Surgical cancellations are costly

When a surgery is canceled due to inefficiencies in the OR — such as poor scheduling or lengthy turnaround times — both the patient and the hospital will feel the fiscal effects. As the OR accounts for about 60 percent of hospital revenues, a surgical cancellation due to lack of beds or a lack of theatre time can result in lost revenue at different parts of the subsequent care process, including inpatient, pharmacy, radiology and home health services.

Dr. Blomberg broke down three potential fiscal losses caused by surgical cancellation and surgical delays,

  • A day-of-surgery cancellation on average costs $3,000.
  • An average surgical delay costs about $80 per minute.
  • A first-case delay can cost $80 per minute in addition to the cost of overtime at the end of shift.

Using the $3,000 cancellation cost estimate, Dr. Blomberg calculated a hospital with a cancellation rate of 1.225 cases per weekday would incur nearly $1 million in lost revenue and opportunity costs annually.

Hospital finances are not the only thing negatively affected by surgical cancellations. Same-day cancellations can also put a patient in psychological distress or adversely affect his or her finances. Surgical patients often coordinate their paid time off around their operations and may even have family members flying in to look after them immediately following the surgery.

Find the best flow to drive efficiency without rushing processes

During the webinar, Dr. Blomberg discussed the importance of hardwiring a productive flow into OR processes. Citing the work of his colleague Kirk Jensen, MD, a leader of emergency medicine at Envision, Dr. Blomberg defined flow as the movement of patients through services and stated each step of the care process should either add value, decrease waste or both.

"An efficient flow creates the right environment for doing the fast things fast and the slow things slow," said Dr. Blomberg. "Being efficient doesn't necessarily mean being fast."

Dr. Blomberg cited seven strategies for improving OR flow and driving efficiency.

1. Take a patient-centered approach to preoperative testing to eliminate unnecessary tests.

2. Review preoperative test results at least one day before elective surgeries.

3. Approach communication as a three-way street between the patient, anesthesiologists and the surgical team.

4. Use block scheduling for surgeries.

5. Make sure the preop area and the recovery area are close to the OR.

6. Use evidence-based medicine to create anesthesia and surgical care standards.

7. Share best surgical practices across all departments.

"Everything [in an operating room suite] should be systematic, logical [and] orderly," said Dr. Blomberg. "[But] nowhere is [efficiency] a license to speed through the critical elements of patient care, instead true efficiency is keeping the correct TEMPO in each part of the process."

Consider the patient's perspective

During the webinar, Dr. Blomberg stated the primary goal of a surgical team and anesthesiologists should be to keep the patient safe and make sure they are satisfied with their care. This can partly be achieved by always keeping the patient perspective in mind.

"This is the most important day of [a patient's] life when they come into the operating room," said Dr. Blomberg. "It's an everyday occurrence for the anesthesiologist, the surgeon and the nurse in the operating room … so we always have to take a step back [and recognize] that it's just another day at work for us, but it's the most important day of their life for that patient."

To view the webinar, click here.

To view past webinars, click here.

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