Operating at Peak Efficiency

By Cindy Borders
Client Account Executive, Streamline Health, Inc.

With value-based reimbursement on the horizon, now more than ever hospitals will be searching for more ways to reduce costs and optimize resource utilization.  Although surgery departments typically generate 60% to 70% of a hospital’s revenue, they are also the one department that has highest per patient allocation of resources for an episode of care. Given this dynamic, OR Management has an outsized influence on profitability.

Whether it is a 15-minute cataract surgery or a two-hour total joint replacement, ensuring all the moving parts are allocated efficiently can be mind boggling.  With supplies and implants consuming up to 60% of a surgery department’s costs, emphasis on controlling supply cost and utilization has long been a priority for cost-conscious organizations. But what about all the other costs related to a surgical episode?  There are many other variable resources—room, staff, equipment and instruments— which can either be managed properly for optimal results, or poorly managed to the detriment of your operational and financial performance.

So… how does an organization manage all of these variables efficiently and effectively? It requires integrated enterprise scheduling to ensure:

• The case is scheduled for the correct duration and the surgeon block time used
• Case is scheduled in the correct room
• Equipment and staff availability are verified
• Equipment is allocated for the only the duration it is needed
• Time is allocated for room set-up and clean-up
• Needed supplies, implants and instruments are allocated to appropriate departments
• PAT visit is scheduled for labs and patient education for day-before preps
• Insurance authorization is obtained and pre-registration is completed
• Patient documentation and patient tracking begins

When there is a breakdown of any of these factors, for even a single case, the negative impact can spread throughout the entire day.  Anyone involved with OR Management understands the “domino effect” that occurs with the first mismanaged event of the day. For examples of how a single misstep impacts various procedures, see the scenarios below.

Wrong Duration Scheduled and Equipment Availability Not Checked

Dr. Smith’s patient is scheduled for a thoracic procedure using a da Vinci robotic system.  The case is scheduled for 1.5 hours on Friday at 7:30 AM.  However, Dr. Smith’s current average for this procedure closer to 2 hours.  On Friday at 7:00 AM when the room is being set up to accommodate his needed window, the da Vinci equipment Dr. Smith needs is still in use in another room.

Effect #1:  Case is going to start late waiting for the equipment from the other room.  Therefore, the case will take longer than 1.5 hours that had been scheduled.
Effect #2:  Each subsequent case in this room will also start late.
Effect #3:  Each subsequent case using the robotic equipment will also be delayed.
Effect #4:  As each case is delayed for that day, overtime will likely have to be paid.
Effect #5: The margin for error with starting subsequent procedures is reduced to the point that any additional delays will likely result in a cancellation. This represents lost revenue and dissatisfied stakeholders who are inconvenienced by having to reschedule.

PAT Visit Not Scheduled

Dr. Wilson’s patient is scheduled for a colonoscopy and EGD for Monday at 8:00 AM.  However, the PAT visit was not scheduled for pre-evaluation and patient education of day-before preps. When the patient checks in at 7:00 AM, the pre-op nurse learns the patient was not scheduled for their PAT visit and has not followed the day-before preps, so the case has to be cancelled.

Effect #1:  Patient has taken off a day of work unnecessarily.
Effect #2:  Day of cancellations is a loss of revenue and cost of unused resources.

Implant Not Ordered

Dr. Hill’s patient is scheduled for a total knee revision requiring a unique prosthesis that must be specially ordered.  Prior to beginning the procedure, Dr. Hill learns the requested prosthesis was not ordered and is not available.  The case has to be cancelled.

Effect #1:  Patient has been prepped, anesthesia has been started and now the case is cancelled.
Effect #2:  Cancelled case means lost revenue.
Effect #3:  Same day cancellation means wasted time and unutilized resources.
Effect #4:  Surgical floor now has an unused bed and lost revenue.

These are just a few examples of how poor management of OR resources can seriously disrupt operational and financial performance. As the focus on reducing costs and increasing margins intensifies, resource/capacity utilization in the OR is an obvious opportunity to create efficiencies and optimize revenues. And this gives new meaning to the concept of “operating at peak efficiency.”