Hospitals and health systems don't just compete with one another to attract patients; they also compete to attract surgeons to perform procedures at their facilities. Based on the competitiveness in this environment, it comes as no surprise that the operating room is a key area where healthcare leaders are focusing to achieve differentiation and to drive efficiencies and cost savings.
To learn more about how minute-by-minute coordination technology is improving OR performance and hospital revenue, Becker's Healthcare recently spoke with Brian Swallow, MBA, BSN, RN, Vice President of Surgical Services at Wesley Healthcare, an HCA medical center in Wichita, Kansas.
Greater visibility into OR operations provides benefits for surgeons, facilities, and patients.
Healthcare organizations with a competitive edge differentiate themselves, attract the most cases from surgeons and are perceived as the hospitals of choice in their community.
To gain a competitive edge, Wesley Healthcare has committed to streamlining its OR operations by using Healthcare Control Systems' ORControlTM platform. ORControl is a minute-by-minute Coordination system that synchronizes clinical staff, equipment, and patients in real-time to effectively manage OR throughput over the next 5 minutes.
"When we schedule our cases in the electronic health record, they are visible on the ORControl board," Mr. Swallow said. "This allows us to see in a Gantt chart the length of time for which they are scheduled. Whenever you look at the board, you get an overall picture of what the day will look like, but most importantly, what needs to be done right now."
A patient is visible on the ORControl board from the moment they enter the admissions area of the hospital. "When the patient arrives at the hospital, the admissions staff clicks their name in ORControl which alerts everyone associated with OR cases that the patient has arrived," Mr. Swallow said. "That alerts pre-op that we can start going down to escort the patient to the pre-operative area. From that point on, we can look at all the timelines for the patient in ORControl. We scan a code into the ORControl system which associates a tracking tag to the patient. This not only allows everyone to see the location of the patient, but this also triggers automated communication to staff, physicians, and families as the patient moves through the Perioperative Process.”
As consent forms and other documents are signed, the chart in ORControl changes color, indicating that a patient is ready to move to surgery. "We are no longer running back and forth from the OR to pre-op to see if patients are ready," Mr. Swallow said. "The system also eliminates a majority of the phone calls that used to happen regularly. We know when patients are ready just by looking at the ORControl board alongside the customized automated alerting pushed to specific groups and departments throughout our medical center.”
ORControl gives teams at Wesley Healthcare visibility into OR operations at seven points of contact:
- When the patient comes to admissions
- When the patient arrives in the pre-op area
- When the patient enters an OR or procedural room
- At the time of the surgeon's first cut
- At the time of the surgeon's close
- When the patient leaves the OR, triggering automated alerts for a room turnover
- When the patient arrives in the PACU
The ORControl board is displayed in the surgeons' dining room, lounge, and also via a mobile application on their smartphone. The integration of mobile visibility and ORC kiosks in these areas, complemented by their alerting capabilities, has notably enhanced surgeons' prompt engagement in On-Time case starts. Surgeons greatly appreciate the ability to see what is happening with their case this very moment just by looking at their phone. In addition, a version of this information, without personally identifiable information, is visible in the cafeteria and waiting areas for patients' families, and on their cell phones.
"When family members can see where their loved ones are in the surgical process, it reduces anxiety and eliminates a lot of calls. The tracking tags associated with patients assure family board updates are accurate and timely since they don’t rely on nurses to enter data. This combined with preapproved messaging sent to families throughout the process has helped us to be a choice hospital in the community," Mr. Swallow said.
OR performance metrics: What gets measured gets managed
With data from ORControl, Wesley Healthcare quantifies key metrics related to OR performance and identifies areas for improvement. Key performance indicators (KPIs) are tracked and reported throughout the organization. "First case on-time starts are a very important metric for surgeons," Mr. Swallow said. "If they can't start on time, even if it's a five- to ten-minute delay, surgeons see a domino effect through the day."
Utilizing ORControl Wesley Healthcare's first case on-time start rate at its hospital and trauma center improved to 86 percent, which is in the top 10% of all hospitals in the U.S. "The more efficient we are with key metrics, the more cases we earn from surgeons. Surgeons measure us on whether we can get them home on time at the end of the day," Mr. Swallow said.
The surgical services department also presents a scorecard to staff in monthly one-on-one meetings to let them know how they are doing. The scorecard includes data like on-time starts, turnover times for operating rooms, physician turnover time and "kudo points" when staff members get positive feedback. As part of a corporate initiative aimed at enhancing physician satisfaction, the ORControl team developed a text reminder feature that enables surgeons to promptly communicate emergent issues or provide commendation for outstanding staff performance immediately following a case.
Data and metrics help Mr. Swallow make the business case for staff adjustments and additional technology. "With data, you're more likely to get funding for a project than if you're just going on a hunch," he said. "When we purchased ORControl, one of the ways we justified the funding was by looking at the FTE balance. We were able to reduce FTEs simply by reducing the number of phone calls and distractions. In addition, if you can demonstrate that revenue will increase due to improved efficiencies, you are also more likely to gain and keep the resources you need to do your job."
More efficient OR operations have translated into more cases per day and more revenue for Wesley Healthcare providing a competitive advantage in the marketplace. "When you average 180 minutes per case, it's easy to add another case on a day during prime time when you have the resources," Mr. Swallow said. "Improving efficiencies is critical when you're operating in a competitive environment."
When selecting technologies to improve OR efficiency, ease of use is essential
One of the reasons that Wesley Healthcare uses the ORControl board is because of its intuitive nature and ease of use for surgeons and staff members. The organization's surgical department sees a constant flow of new medical students. An attending surgeon can walk up to the ORControl screen with five residents and explain the board in 30 seconds.
"It's so intuitive that they instantly know how to use it. Rapid adoption of software is unique in healthcare settings and creates efficiencies within the surgical team, as well," Mr. Swallow said.
While many technology solutions promise to deliver efficiency gains, they go unused because they are hard to understand.
"ORControl is very easy for everyone to use from transporters to doctors to staff," Mr. Swallow said. "And it's easy to draw the data out for analysis. Every quarter, we have three quarters of a million touches on the system as people look at ORControl to gain critical minute by minute information to make informed decisions and prepare for their next case.”