The power of minute-by-minute coordination in operating OR’s: How one Ascension hospital is driving efficiency + revenue with coordination technology

The operating room is a key focus area for healthcare leaders looking to drive efficiency and cost savings across their organizations.

However, the information they use to understand causes of delays, safety incidents and other barriers to efficiency is usually retrospective — an inaccurate reflection of what is happening right now, and more importantly what can be done this very minute to avoid delays and patient safety issues over the next several hours.Leading hospitals today now use minute-by-minute coordination systems to provide their frontline teams with just the right information at just the right time, helping them navigate the constant disruptions that they encounter throughout each day.

Becker's Healthcare recently spoke with Frank Sciolino, director of surgical services at Ascension Saint Thomas Hospital Midtown (Nashville, Tenn.) about the benefits of using a minute-by- minute coordination system. Mr. Sciolino described how such a system can help OR staff organize their work more efficiently, achieve cost savings, increase throughput and revenue and even elevate his hospitals' appeal to job candidates.

Accurate, minute-by-minute coordination can help transform the OR

Once a patient is in the OR, there are up to 150 human touches that must be coordinated among the surgical team for that patient to go through a procedure safely. The high number and complexity of those touches are a challenge to efficiency. But with a coordination system, healthcare leaders can instill a culture of accountability and motivation that expedites OR cases and improves patient safety.

Ascension Saint Thomas Hospital Midtown looks at four key performance indicators to determine whether surgical cases are handled efficiently:

  • First case on-time start (FCOTS)
  • Turnover time
  • Safety metrics
  • Financial metrics related to value

"If I can't get my first case of the day started on time, I've got either a system problem, a behavior problem, an equipment problem, or a staffing problem," Mr. Sciolino said.

To fix recurrent FCOTS delays or other issues, leaders need a system that captures the reason behind a problem at the precise moment it is happening, so that staff can fix it now before it becomes a trainwreck. Such a system may reveal, for example, that an anticipated late case start is not due to a pharmacy delay, but rather a physician still needing to put in the medication order.

The challenge is that traditional IT systems and KPIs do not capture such information and more importantly, do not allow staff to adjust their activities in real time to such setbacks. "If you think of KPIs like the dashboard on your car, when we look at them, it's like looking at the speedometer — but the destination is out the windshield," Mr. Sciolino said. "We have to make sure we're looking out the windshield and not just at the performance metrics."

ORControl™ enables holistic minute-by-minute coordination that generates efficient OR throughput

Healthcare Control Systems' ORControl™ is designed to provide hospitals with minute-by-minute coordination across all procedural areas. The system makes just the right information immediately available to all staff about the status of rooms, procedures, patients, schedules, and equipment.

Thanks to its forward-looking design, ORControl alerts staff when a delay is likely or when a patient is ready to be transitioned from the OR to the post-anesthesia care unit (PACU), so PACU staff are ready to receive the patient — details that a backward-looking dashboard cannot provide.

"The ORControl system allows hospital staff to distill that information down to the key, meaningful parts," Mr. Sciolino said. He noted that the technology's capability to display historical and real-time information, as well as summary statements, has immense value for leaders. "I can have real-time reports that tell me the order of the patients, where the patients are, what time they arrived in the building, what time they got into pre-op and so forth," he said. "You're watching the productivity and utilization of your resources throughout the day and can focus on real-time trouble spots."

ORControl™ drives improvements beyond the OR

Over the past four years, through its use of ORControl, Ascension Saint Thomas Hospital Midtown has realized meaningful improvements in several key areas:

  • Improved FCOTS metrics: Increased from 35% to 72% when tardiness is set to 0 minutes, and increases to over 95% when tardiness is set to the industry standard of 10 minutes
  • Faster turnover: For all surgical specialties, turnover time decreased from an average of 35-40 minutes to 30-31 minutes.
  • Higher surgical volume: Average OR volume increased from 850 cases per month to 1,200 cases per month. This increase in surgical volume translates directly to increased revenue.
  • Enhanced patient satisfaction scores due to more consistent information and decreased communication delays.
  • Strengthened team culture due to a greater sense of "owning" and influencing the environment that staff members work in, which drives greater discretionary effort.

A less tangible but equally critical improvement has been the reputational boost of the hospital as a preferred place to work, Mr. Sciolino said. In today's competitive recruiting landscape, this system makes a difference.

"As we've been able to develop those efficiencies, Ascension has become the place they want to work."

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