Assessing, scheduling with surgical precision

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Paige Patterson, RN, BSN, House Supervisor at University of Colorado Health (UCH), says what she and her clinical colleagues really want when they go to work is “a reliable, positive patient and caregiver experience.”

That’s probably the primary goal of practically every other clinician working in a healthcare facility as well — but reaching that goal can be a lot harder than it sounds, especially for those working in the surgical suite, where rarely is anything static or predictable.

Patterson works in a clinic setting at UCH but the communication, preparation, planning and efficiency challenges that she faces are similar to some of the obstacles encountered in critical care environments too.

Paige Patterson

At Patterson’s facility, four long halls are lined with exam/procedures rooms, each featuring an exterior light. When the light is on that means there’s a patient inside, maybe a caregiver as well. Physicians also used the light to signal to staff when lab orders needed processing. Patterson says it wasn’t the best way to track people and events but that’s how it was done.

“The lights were not visible unless you looked [or] partially walked down the hall,” explained Patterson. “Oftentimes staff would close curtains in the rooms if they wanted to save it for a patient or procedure. And, patients would wait — and wait — in the exam room because staff had to find the physician to tell them the patient had arrived. Physicians would order labs and activate the light outside the room, and it was the responsibility of the staff to notice the light, but they did not always know which patient was first with the request.”

Clearly that strategy was outdated, inefficient and hardly provided the “reliable and positive” experience Patterson and her colleagues were seeking. To get them closer to that goal, UCH implemented TeleTracking’s Clinical Workflow Suite software solution with a real-time locating system (RFID/RTLS). This allowed them to automate those manual processes and remove the unnecessary guesswork that used to gobble up precious time. Today patients are spending 13 fewer minutes between check-in and in-room transfers. TeleTracking platform gives caregivers in halls and dictation rooms a visual of exactly how long a patient has been waiting in the lobby. Now, when patients are assigned to a room their location is immediately updated on the board and an icon also indicates if an RN, MA, DR or mid-level provider is in the room. The system also eliminates the need for visitors to spend time at the front desk waiting around to find out where their loved ones are. Labs and EKGs ordered electronically are also reflected on the board, including the time of the order so that medical assistants can work more efficiently.

TeleTracking’s Clinical Workflow Suite application

Moving on to the OR

Chelsie Corbett, TeleTracking’s Product Manager, says Clinical Workflow Suite also supports OR staff with first and subsequent case on-time starts, procedure room utilization and turnaround time, case duration accuracy, and patient wait-times.

At Health First in Melbourne, FL, for example, Corbet said “on-time case starts have improved by 50 percent; room utilization during prime-time has increased by an average of 45 percent and room turnover time decreased by 30 percent — wheels out to wheels in.”

Huntsman Cancer Care Center, University of Utah, also uses TeleTracking and has cut more than 100 daily phone calls between the front desk and nurses and eliminated over 200 daily patient status calls between nurses and pharmacists. It also generates alerts for when medications can be picked up, removing delays in the infusion process.

Brett McGreaham, Senior Product Manager, Versus Technology, says his company’s product, the Versus Advantages OR, is an automated patient flow solution based on RTLS technology with an analytics package that provides insight into patient wait times, pre- and post-op times by procedure, OR suite utilization, staffing utilization, etc.

“The main goal of this technology is to help clinicians spend time where they most want to work — with patients,” said McGreaham. “Any time they spend away from the bedside completing non-value added tasks, such as data entry or searching for equipment, is a source of frustration and contributes to staff burnout. Facilities are being asked to do more with less, to see more patients while still improving outcomes. Investing in tools that help staff increase their productivity is essential.

Versus Advantages OR floor plan

“Versus Advantages OR provides real-time visibility into the status of patients, staff, procedures, and equipment,” McGreaham continued. “Just by wearing locating badges and with virtually no manual input, staff no longer have to search for one another or peek their heads into rooms/bays to see which tasks are complete. OR teams can see where patients are in the pre-op process to plan appropriately. Likewise, pre- and post-op teams have real-time insight into the OR so they can be ready to send patients into or receive patients from the OR. Similar workflow solutions require staff to “click” the patient from location to location, or notate that the anesthesiologist has been with the patient, or that the surgeon has done his pre-op check. By applying intelligent rules to the locations of patients and staff, Advantages OR automatically documents and communicates these standard patient milestones.

Everything happens in real time, instead of when the staff member has time or remembers to advance the stage of a patient. Did the anesthesiologist visit the patient in Bay 1 or Bay 2? With our technology, it’s relatively inexpensive to accurately sense multiple locations within open pre- and post-op areas.

Jeffrey Robbins, President and CEO of LiveData Inc. says his company’s integrated OR planning and scheduling solution captures real-time operational workflow data to give OR managers and other leaders the complete case-level data needed to make educated, informed clinical and business decisions.

“LiveData scheduling begins with the patient’s pre-surgical planning,” said Robbins. “LiveData PeriOp Planner is a web-based, interactive application with two integrated tools: LiveData Service Block Planner and LiveData Surgery Planner, which includes PreOp Workup, a customized preoperative milestone checklist for each patient. Case information and patient readiness status is updated in real time and is shared, tracked, and analyzed to improve scheduling confidence and accuracy while reducing cancellations.

LiveData PeriOp Planner

“A virtual, interactive appointment book displays daily schedules of resources, blocks, and cases, making it easy to visually plan and manage the day’s case schedule for each surgical block,” Robbins continued. “Service Block Planner enables scheduling staff to create, review, and edit the facility’s standard block schedule or modify it to accommodate exceptions such as outages due to vacations or conferences. This fine-grained control over blocks makes the product’s analytics trustworthy by clinicians, since it reflects these planned outages in its utilization statistics. Surgeries scheduled with PeriOp Planner systems are electronically managed on LiveData OR-Schedule Board and displayed on monitors in the surgical suite. The dynamic, real-time view of the day’s surgical caseload is automatically adjusted as cases may finish late or early. OR managers have interactive drag-and-drop tools to adjust rooms, cases, and resources to create surgical capacity and increase utilization and access. Predictive analytics track OR rooms running to support staffing requirements. OR schedule changes are automatically communicated to perioperative teams securely over the network.

“As surgical cases proceed in the OR, LiveData real-time integration technology captures operational data. The data flows automatically into LiveData PeriOp Manager Analytics eliminating manual data entry and additional preparation steps that impede access to timely and accurate knowledge. PeriOp Manager Analytics assimilates, aggregates, and organizes real-time perioperative workflow data to provide OR managers and hospital leadership with real-time and historic data to make informed clinical and business decisions. Users can explore data by service, operating room, case, CPT code, and individual provider to reveal patterns and associations that allow managers to optimize throughput, resource utilization, workflow, efficiency, patient safety, and clinical quality.”

Jeff Terry, MBA, FACHE, General Manager and Managing Principal, GE Healthcare Partners, says GE’s HoF Block Optimizer and HoF Simulation tools helps facilities improve OR utilization by engaging physicians with advanced analytics. “The tool ‘defrags’ the OR schedule so we can play ‘what if’ with surgeons,” Terry said. “We use a constraint-based optimizer to the optimal design. That means it keeps surgeons happy, increases utilization, minimizes disruption, balances downstream outflows, and creates space for growing practices.

“In other words to design a schedule that’s good for not just the OR and PACU, but also the ED, ICU and surgical units,” Terry continued. “For example to not mass all the ortho or cardiac cases in such a way to create variation in the associated nursing units. This is very complicated math with so many patient types, post-surgical length of stays, case durations, etc. Changing a surgical schedule is like diplomacy at the UN … massively political and difficult. Our tool allows us to test alternatives in a high-fidelity manner. But we still have to work intimately for months with leaders, physicians and clinic staff. It’s major change powered by data. The ability to model impact on downstream units in a granular way is new. This has massive impact for length of stay, patient throughput, and ability to create access for complex patients.”

HoF Analytics Platform by GE Healthcare

University of Southern California Keck Cancer Center implemented the GE tool to redesign the schedule and tweak processes and later saw an 11 percent increase in surgical volume while John C Lincoln Hospital in Arizona improved first case starts and room turnovers by 10 to 40 points each. “The next horizon is prediction,” Terry added. “We are more and more often predicting bottlenecks … this is in addition to trying to reduce their frequency. The truth is that healthcare will always have some variation so we have to do both: reduce likelihood of congestion AND spot it when it starts to happen so we can do something about it.”

If surgical staff routinely encounter bottlenecks caused by procedure delays, emergency add-on cases, cancelled cases, equipment failures and procedure that go beyond expected timeframe, staff and patients suffer, economic health suffers and a hospital’s reputation can take a serious hit.

“These challenges can sap the energy, morale and productivity from the most talented surgeons and staff, and can ultimately impact patient care and the hospital’s bottom line,” said Gulam Khan, Senior Vice President, Procedural Solutions, STERIS. “In addition, hospitals across the U.S. struggle with limited numbers of operating rooms. Many hospitals lack the physical space or budgets to build more. Some of these hospitals have sought a way to maximize patient throughput and increase OR capacity levels to generate additional revenue — without having to bear significant capital expense to accomplish their OR utilization improvement goals.”

STERIS’s Situational Awareness for Everyone Display (S.A.F.E.)

Lena Fogle, RN, BSN, CNOR Director, Global Clinical Solutions, STERIS, offers a solution to address those concerns. “STERIS’s RealView Visual Workflow Management Software instantly captures key performance events that can dramatically improve OR utilization, communication and continuity of patient care,” she said. “It provides perioperative staff with the ability to manage workflow in a hands-free, ‘air traffic control’ mode. The real-time system alerts staff about potential bottlenecks while also providing instant notifications to physicians and staff to keep surgical schedules moving and on time, which helps optimize OR throughput. RealView Visual Workflow Management Software utilizes RTLS enabling technology to instantly capture patient progress along every process point within the perioperative workflow. The software delivers instant and accurate views of patient workflows at all times for perioperative staff on large, highly visible flat-panel displays posted in pre-and post-op areas, surgeon and OR staff lounges, in every OR, and in surgical family waiting areas. “STERIS’s Situational Awareness for Everyone Display (S.A.F.E.) provides the OR team with real-time, up-to-date, accurate patient data from disparate hospital sources. It helps optimize patient safety and workflow efficiency for every procedure,” continued Fogle. “The display eliminates information delays and manual checklists while significantly reducing the potential for a “never” event. S.A.F.E. provides a dynamic view of clinical information on a dedicated, easy-to-read display to optimize clinical decision making and patient safety. It helps OR staff safely navigate through Sign In, Time Out and Sign Out requirements for every surgical procedure while encouraging best practices and optimal patient outcomes.”

Tara Vail, COO, Healthcare Systems & Technologies (HST) said “One of the biggest challenges supply chain leaders and value analysis team have today is trying to capture the true cost of the case. In many surgery centers, the clinicians are using paper based preference cards to pull supplies for a given case. Once the case is complete, someone has to go into the surgery center management software and enter in the supplies that are used. If that is not done, or is not done accurately then the inventory is not depleted correctly and the true cost of the case is not captured. Additionally, the most expensive supplies used for a surgical case are implants. Too often there is disconnect between logging the implants in the clinical chart (aka Implant Log) and systematically capturing that implant on the supplies used for the case. That disconnect has even larger financial implications because in some cases it could mean lost revenue if the implant is not billed on the claim when the payer allows it. It also presents challenges for the value analysis team when they try to develop a base line for case costing across specialties, procedure types, and physicians.

eChart by Healthcare Systems & Technologies

“HSTpathways has a fully integrated charting solution called HSTeChart. HSTeChart’s design leverages preference cards to the fullest. By leveraging the preference card to the fullest, the clinician is incentivized to keep that preference card as accurate as possible. When the preference card is completed to the fullest extent the medications, the equipment, the likely implants to be used on a case, the supplies, physician and anesthesia orders, patient position, and discharge instructions are pulled into the appropriate areas of the patient’s chart. That information then only has to either be confirmed by the charting clinician, or simply update the changes that are applicable for that case. This is a huge timesaver for the clinician who has to document this information as part of the standard, audit-compliant patient medical record. Once the charting for the patient is complete, that information is automatically captured in the supplies used for the case. The implant log for the case is automatically updated and completed. Additionally, the billing information for implants is included with the supplies used and can then be billed on the insurance claims with no potential of lost/uncaptured revenue. Supply chain leaders have the most accurate representation of the supplies used in almost real-time. The value analysis team has the truest case costing options possible as well. For the value analysis team, they not only have accurate case costing related to supplies and implants, but they also have accurate resource utilization that is pulling directly for the eChart.”

Ben Resner, Vice President, Solutions, Hospital IQ, says his company’s cloud-based platform integrates with most existing electronic scheduling systems to provide an interactive data program with no hardware buildout required.

“The Hospital IQ platform is purpose-built for perioperative operations and fits the unique workflows associated with a hospital system, campus, department, surgeon, and surgical procedure,” said Resner. “Our platform leverages a hospital’s existing data to provide the actionable operational insights that increase patient throughput, optimize procedural spaces, improve patient and staff satisfaction, and cut costs to increase ROI.”

Hospital IQ’s Surgical Planning platform

 Hospital IQ also produces data that staff can relate to — information they can use right away to improve how surgical care is delivered.

“Clinicians and hospital leaders are used to seeing reports, but they don’t trust them,” Resner asserted. “Interactive reports combined with predicative analytics give leaders the certainty needed to improve utilization and efficiency of their ORs.”

Resner gives a snapshot of how Hospital IQ’s solution improved processes and outcomes at a Midwestern urban hospital that performs total joint replacements at its main and suburban campuses:

“Utilization was disproportionately skewed to Monday and Tuesday. This led to a spike in inpatient bed demand and associated services every Tuesday and Wednesday with commensurate under-utilization later in the week. Hospital IQ’s solution characterized the historical procedure distribution being clustered at the beginning of the week as the norm. This simple reporting task was something difficult for their existing canned system.

“Hospital leadership wanted to consolidate the ortho services to the suburban campus and then smooth the utilization of the OR,” continued Resner. “Surgeons and nursing staff were concerned that Friday’s surgical patients would still be in the hospital on Monday. Using historical length of stay data in Hospital IQ’s interactive scenario planning, leadership was able to view the distribution of likely outcomes. They chose a plan that would add surgeries later in the week to increase overall surgery volume but the demand on inpatient beds or concurrent ORs would not go over their existing high-water mark.

Since implementing the solution, this hospital has seen a 44 percent increase in orthopedic surgery volume with no increase in peak bed demand or concurrent OR demand. This could not have happened without the predictive analytics and data transparency of Hospital IQ. Nobody makes a dramatic change to a surgical schedule simply based on a ‘hunch.’”

See sidebar: The evolution of analytics in OR scheduling

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