Ready, set, go

Many people, departments and circumstances may complicate scheduling and surgeries, explains Shayan Zadeh, Founder & CEO, Leap Rail. “Let’s think about all the different elements required for scheduling a successful surgical case. You need to take into account patient and surgeon availability. This needs to be paired with operating room availability, including the business rules for accessing them (block schedule, priority access, etc.), special equipment requirements, anesthesia and nurses’ availability, implants, supplies, preference cards, vendor rep availability, and so forth. Once you consider the interdependencies between all these elements, the required coordination level for clinic staff or an OR scheduler is daunting.”

Human error and physician availability can cause scheduling inaccuracies, acknowledges Ashley Walsh, Director, Client Services, LeanTaaS iQueue. “The physician notes that are sent to scheduling can be hard to read or interpret. Often a physician’s description of a procedure does not perfectly match the procedure names in the EHR that an OR scheduler has to choose from. Frequently there are non-clinical individuals doing the OR scheduling, which gives them a disadvantage in that they have not worked in the OR on a surgical team and are not clinically trained. On top of that, there are other additional complexities such as understanding if the physician who is trying to schedule a procedure has block time, and if not, is there open time that the case can be put into? If there is no block time and no open time, the case has to be put into a queue, which means the physician, and more importantly the patient, cannot receive a confirmation until often the day before or day of regarding whether or not the procedure can take place for sure and what time.”

Older processes may impede scheduling and turnover, Walsh noted. “Mostly there are broken processes that have simply been grandfathered in. Hospitals, and more specifically ORs, need more sophisticated tools than simply implementing EHRs. ORs need more efficient communication with physician offices, and they need to embed the institutional knowledge of the scheduling process into lean processes optimized with better math to ultimately yield increased efficiencies that include turnover, scheduling and total volume.”

She pointed to the LeanTaaS iQueue for OR suite to timely communicate scheduling information to the team. “The iQueue aims at increasing access to ORs through better scheduling, increasing accountability with how block time is monitored and repurposed, as well as increasing visibility into what the data is telling us – pushing data automatically through mobile and web to all users (surgeons, administrators, etc.), so that everyone can have more data-driven conversations that are backed with trustworthy data. For those that want raw data and the ability to slice and dice on their own, that can be accomplished, but for the older surgeons who are not as mobile/internet savvy, we push information directly to them, which can be viewed through a simple text message with easy-to-understand visuals.”

The suite has saved both time and money, she added. “Our tools will allow physician offices to schedule surgeries sooner so that the patient wait time is less. There is tremendous value in increasing efficiencies and doing more in their business hours. The median prime time utilization increase for our customers that have been live for a year or greater is 6%. Doing even 1% more volume means a very significant financial return when it comes to revenue in the OR! In general, the most consistent feedback we hear is how much iQueue has enhanced the scheduling process for cases done outside of block time (this is roughly 35-50% of all cases) for the OR scheduling team as well as the physician offices’ scheduling team(s). In addition, we hear that iQueue helped create a single source of truth for reporting metrics.”

Multiple individuals with different responsibilities in different locations trying to coordinate the surgical journey can break down scheduling, states Jeff Robbins, LiveData Founder and CEO. “Surgical scheduling is inherently complex. It reaches beyond the simple surgical appointment slot to include patient pre-operative tasks, prepping the patient on the day of surgery, and often includes follow-up actions. Scheduling access is also not confined within the hospital walls. Patients with their family members, along with nurses, anesthesiologists and surgeons (who are often not employed by the hospital) need access and input to surgery schedules.”

An absence of up-to-date information can disrupt scheduling and attendance, Robbins affirmed. “The inability to share real-time information across the community of individuals involved in a patient’s entire surgical journey contributes to inefficiencies in surgical scheduling. Another challenge is that surgery requires patients to complete a list of pre-operative tasks to ensure surgical readiness. A lack of real-time status on progress against this list can cause last-minute cancellations. Giving everyone involved in the surgical process appropriate access to the information they need, no matter where they are, eliminates issues like patients arriving for surgery with incomplete pre-operative tasks, thus forcing the cancellation of surgery. For the OR team, being able to see the status of a patient in the perioperative process helps them move patients through the surgical preparation process and keep the surgeries moving on time.”

Scheduling surgeon time can be difficult, expresses Jason Harber, SVP, Product Management and Marketing, Hospital IQ. “On average, 80% of OR time is allocated to specific surgeons, surgeon groups or service lines. For these surgeons, it is less of a challenge because they have great visibility to the times that they can book cases into. Conversely, for surgeons that do not have block time, or need time outside of their block, they lack visibility to the availability of times that are available for them to book into and the process of finding open OR time is manual and tedious.”

Slow updates of unused time may hinder planning, Harber added, “If a surgeon knows they won’t use a specific block of time, they should release that time early, which enables other surgeons to book into it. While surgeons have the best intentions, they don’t typically release their blocks early enough for other surgeons to utilize the newly created time. Perioperative departments have implemented auto-release policies for unused time, but these typically take place 24 to 72 hours before the block time, which is not sufficient for other surgeons to claim for their cases. Predicting OR time that will not be used, prompting surgeons to release it early, and making it available for other surgeons through a marketplace-like experience removes a lot of the cumbersome and manual processes that are currently required just to understand what OR time might be available to book a patient case into.”

He suggested Hospital IQ’s Perioperative solution as a means to deliver current information and data. “Hospital IQ’s Perioperative solution helps improve OR throughput, which includes turnover time, by giving real-time visibility to the current performance of the rooms running in the OR, as well as predicting which rooms will need to be run to accommodate each day’s cases. In addition to these predictive and real-time capabilities, Hospital IQ automates the creation and distribution of tailored scorecards of key operational metrics that can be shared with all stakeholders to build consensus on the actions needed to make improvements. Our platform uses simple and clear emails to communicate actions, needs, performance, etc. Many users experience Hospital IQ via wall displays throughout the Perioperative department to understand the status of the current day’s cases, as well as overall performance of the department. In addition, it predicts which surgical blocks are most likely to go unused, giving other surgeons and schedulers the opportunity to book cases and fill those primetime slots.”

Multilevel communication can cause a lag in scheduling, acknowledge Vicki Harrison and Mark Stega, MD, Optimium Health. “Inefficient communication between surgical offices, surgical posting, and the pre-anesthesia teams at the hospital or surgi-center is the primary problem area. Most communication occurs via FAX, which often has inherent legibility and timeliness issues. Phone communication is also an issue when messages are not picked up on message machines or passed on accurately or in a timely manner.         

This may slow down or halt surgeries and impact patients and costs, Harrison and Dr. Stega explained. “There can be 75-150 information exchanges that occur between a surgeon’s office, the perioperative department at the hospital or surgi-center and the patient at the primary level, and secondary information exchanges between finance/insurance, equipment, and device ordering and surgical supply and tray management. If any or several of these information exchanges is incorrect, untimely or omitted altogether, an on-time surgery is at risk. Case delays and cancellations are very stressful for patients. Reducing unnecessary changes and uncertainly will improve both patient and family caregiver satisfaction and goodwill.  Staff will benefit because they will spend less time “putting out fires” due to communication errors, omissions, and untimely exchanges. Eliminating unnecessary clerical work will put staff focus on the clinical work to be done, which is what they enjoy, and what ultimately drives successful patient outcomes. And for the hospital or surgi-center, improved staff productivity will reduce the cost per patient and potentially provide incremental revenue due to improved patient throughput.” 

They presented the Optimium Health OPTIMI$ER application to support integrated communication across the team. “Optimium Health’s OPTIMI$ER is a workflow assistance package that is tailored to improve the entire perioperative process from the initial surgical consultation to patient discharge and follow-up. It serves to improve the efficiency and organization of the team members involved in the process and ultimately reduces delays and cancellations, creates high OR throughput, and improves patient safety. In general, all of the OPTIMI$ER products work by utilization of electronic checklists, dashboards, business rules, and real time reports. Each served business segment implements a different set of these components that are tailored to the institution’s particular workflow.”

The system has increased workflow transparency and reduced procedure delays and cancellations, they addressed. “After implementation of our OPTIMI$ER, nursing satisfaction went from 28% to 78%.

Inconsistent cleaning processes contribute to an unsanitary and unsafe work and care environment, says Linda Homan, RN, BSN, CIC, Sr. Manager of Clinical Affairs, Ecolab Healthcare. “Our experience has shown that cleaning and disinfection in the OR is not consistently or thoroughly done. The biggest challenge is the pressure to turn over the room quickly, coupled with a lack of clearly defined processes, roles and responsibilities for this task, which creates inefficiency and a situation where some surfaces are cleaned twice while others are not cleaned at all. The environment has long been considered a vector for the transmission of healthcare-associated infections. Improved processes for surface cleaning and disinfection not only improve turnover times, but also decrease environmental contamination and potential for transmission.”

Lack of training and communication among staff may cause a breakdown in turnover, Homan expressed. “Inefficiencies in the OR can be attributed to a lack of communication between department managers, clinical staff and OR turnover teams, a lack of training and standardized processes, and not having the right cleaning tools and chemistries at the point of use. Products alone don’t improve thoroughness of cleaning or significantly impact turnover time, and neither does monitoring or training. Think of this as a formula that combines product, process and practice. You need all three in order to deliver high quality, consistent performance.”

She proposed the Ecolab OR Program to improve process consistency and results. “The Ecolab OR Program delivers standard environmental hygiene to drive quality, consistency and efficiency through evidence-based practices, resulting in proven and sustainable results. In addition to chemistry, cleaning tools, training and consultative service, the digital dashboard with real-time reporting enables managers to track high-touch object cleanliness and turnover time in operating rooms so that targeted performance feedback can be shared with turnover teams. The Ecolab OR Program delivers faster OR turnover time, improved cleaning results, a reduced risk of HAIs, enhanced operational efficiency, process standardization and consistency, and ensured compliance with professional guidelines from organizations such as AORN and AHE, all of which contribute to measurable improvements in clinical, operational and financial metrics for the hospital.”

The program has generated better cleanliness, staff satisfaction, cost savings and turnover times, she reported. “A 576-bed quaternary care hospital with 27 ORs performing 23,000 surgeries a year implemented the OR Program. Within two months of implementation, they improved between-case high-touch object cleaning by 66%, decreased room turnover time by an average of 21 minutes and increased staff retention to 86-100%. These efficiencies helped the hospital achieve a significant cost savings with each room turnover.” ¹

Change of staff can interfere with the turnover process and costs, says Champion of Cardinal Health. “Speed and efficiency are important, yet difficult to achieve. OR time is money. The biggest breakdown in an OR’s revenue generation is during room turnover and room setup; from patient out to patient in. Another huge challenge is that in every facility, the people turning over the room may be different. Environmental services departments and janitorial staffs can have high turnover rates, making it very difficult to maintain consistency. Balancing these can be quite the tap dance at times.”

Moving patients, procedure types and inconsistent cleaning processes may interrupt workflow, she added. “Transitioning patients from the OR to the PACU—if the patient is difficult to move safely for any reason, can slow down turnover. What shape was the room in last? Was the previous case a trauma or a carpal tunnel surgery? Some surgeries are definitely messier than others. Also, what procedure are you preparing for next? Based on the complexity of the next procedure, turnover could stall, as some procedures take longer to prepare for than others. A consistent process is the most important factor for successful turnover. One of the most important contributors to consistency is having the right supplies to effectively clean up; then having the right supplies to successfully prepare the room for the next procedure.”

She advises Cardinal Health’s Presource OR Turnover Kits and Presource Kitting Solutions for OR Setup to keep the OR clean and moving. “The products provide consistent supplies that support the particular processes of any facility. They promote efficiency and inspire confidence for the end user that the correct products to turn the room are available, and reliable.”