Getting prepped and rolled into the operating theater for a surgical procedure is one of the most important days — if not the single most important day — in a patient’s life. That’s according to Erin Kyle, DNP, RN, CNOR, NEA-BC, Perioperative Practice Specialist, Association of periOperative Registered Nurses (AORN). For a variety of reasons, this is probably an accurate assessment. However, it’s probably true also that most patients aren’t thinking about (nor should they have to) the many variables that go into scheduling their case that day and how fundamental the process is to the operation’s success or failure.
“The complexity of surgery is now at a level where changes can happen on a daily basis,” Kyle said. “Coordinating all of the people, equipment, and supplies at the time of scheduling can literally look different from day to day for the same procedure type with all of the advances in technology. In today’s technologically advanced society and especially in healthcare, many details are inputted into scheduling programs that feed into workflows for all that coordinate care of the patient,” said Kyle, citing an automated internal defibrillator implant procedure as an example: “Scheduling is responsible for inputting information and informing all of the specialists and caregivers who are needed for the procedure. In this case, the imaging department and the device representative must be present for the procedure for device placement and programming. If accuracy in scheduling breaks down, all of the key players may not be present with all of the needed tools, supplies, and implants needed for the case at the right time.”
Scheduling mistakes and their consequences
Consistent accuracy and throughput requires the successful management of many interlocking components. As Kyle pointed out, miss just one and it has the potential to create a negative ripple-effect on surgical outcomes, time, patient satisfaction and money; and it most certainly frustrates surgeons and causes undue stress and anxiety for the entire surgical staff.
“The top three challenges facing perioperative professionals are on time starts, room turnover and add-on cases,” asserted Eric Burch, Associate Principal, Vizient, Inc. “Failing to start on time throws your schedule off and even one delay has a cascading effect on every procedure that comes after. Optimal surgery scheduling is one which demand for the OR rooms and resources is aligned and planned accordingly. It also keeps all required staff informed and ready to meet the needs of the patient and the surgeon.”
Gavin Fabian, CEO, Casetabs, believes if OR staff is struggling to keep cases organized and on track then communication and coordination are probably the top culprits that need to be addressed. “There are many moving parts when scheduling a case and seeing it through completion,” said Fabian. “Ensuring everyone involved is properly scheduled and kept up-to-date on any changes or updates is a difficult task, especially considering many of these people work outside of the facility.”
Getting it right requires taking a multi-pronged approach fueled with smart people, processes and technology. And while advanced technologies are available to mitigate challenges and support scheduling tasks, some departments still rely on inefficient, antiquated tools and methods to schedule cases. “It is usually a fatal combination of technological backwardness and improvised, sometimes haphazard, processes,” suggested Justin Rockman, Vice President, Sales and Development, Surgimate. “The irony is that in the U.S., the world’s most advanced surgeries rely on the least-advanced back-offices. We’re talking about an industry that still considers the fax machine a daily workhorse! Not once have we encountered cutting-edge practices still using typewriters and couriers to shuttle paperwork between facilities. They’re decades behind the curve when it comes to real-time communications, cloud-based applications, and digital collaboration tools.
“Surgeries have become hugely complex events, with up to 50 individuals involved in a single surgery. These stakeholders experience major challenges sharing patient data as there is no interoperability between systems,” Rockman added. “Even though groups are entering information into digital systems, sharing that information still means generating mountains of paperwork.”
It would seem unrealistic then — even risky — for a surgical department to continue storing case-related data in separate silos and using error-prone methods to disseminate it.
For those who are ready to invest in an upgrade, plenty of sound solutions exist.
The cloud with the silver lining
Among the surgical teams that have adopted advanced OR scheduling software, most will choose a cloud-based structure — and for good reason, according to suppliers and end-users. Unlike traditional phone, fax and text delivery, methods that are still in use at many hospitals, cloud-based scheduling systems collect all inputs and simultaneously deliver up-to-date communications to everyone involved in a surgical case, provide robust predictive analytics, and other useful components that can help facilities discover opportunities for substantial growth and savings.
“Similar to a project management tool, a cloud-based surgery coordination system simplifies tasks by providing an at-a-glance view of where a patient is at each step of the case, from scheduling all the way through discharge,” explained Fabian, Casetabs. “These systems allow case teams to be easily added, enabling communication and coordination to ensue around the case. Phone, fax and text updates are replace by automated alerts sent to every person involved in the case, including vendor reps, each time an update or request is made which ensures everyone remains current on case details. When using a cloud-based system, information is easily accessible to those who need it, regardless of location, either through a laptop or mobile device such as an iPhone or Android.”
Casetabs tested their scheduling technology with participating surgery centers which Fabian says relied on a system that entailed a near-total of 25 touch-points, including calls, texts, emails and whiteboard updates. The Casetabs system whittled it down to just five touch-points and a central hub that gave everyone involved in the procedure universal access to case information in real time.
“Crown Point Surgery Center is a great example,” said Fabian. “With 450 cases each month, the center’s clinical and business office teams were spending significant labor hours on surgical case communication and coordination. Simply trying to ascertain where each patient was in the pre-op process was labor intensive and prone to error when relying on traditional manual methods. After implementing Casetabs, Crown Point was able to greatly reduce communication touch points. The result was more than $6,500 in savings per month in labor hours (82 front office hours and 123 nursing hours per month).
The technology also connects physician offices with surgery centers and hospitals, which in turn increases case load and revenue.
“Buena Vista Surgery Center’s Medical Director, Dr. Raymond Raven, cites a 10 percent increase in case volume since deploying Casetabs,” continued Fabian. “He attributes this increase to the ease of which physician office staff can conveniently and safely schedule cases at his center. According to Dr. Raven, the center has seen a direct path from cloud-based surgery coordination to increased caseloads.”
Sanjeev Agrawal, President and Chief Marketing Officer, LeanTaaS, says seamless surgical scheduling means employing technology that will deliver a marked improvement to existing workflows. “It’s one of optimized scheduling through predictive analytics, which technologies like mobile, cloud and machine learning make possible,” Agrawal said. “Identify and make available block inventory to surgeons and clinic schedulers needing block time. Let them easily discover and request/release blocks with a single click on their mobile device. Eliminate the need for phone calls, emails and faxes. Monitor booking patterns to identify blocks that are likely to be underutilized.”
Agrawal says UCHealth implemented the LeanTaaS system and was able to increase overall financial performance by more than $450,000 per OR per year. “Average aggregate block utilization is up by over 4 percent; 11 new surgeons have been hired into the system despite a lack of permanent block time for them,” he said. “Release lead times have lengthened to almost 27 days, allowing more surgeons access to the OR more often. Block allocation is a fairer and more data-driven process. Surgeons and administrators have more trust in the data upon which block allocation decisions are made.”
For facilities using the Surgimate product, they too are enjoying impressive results. “One practice was able to cut booking time by 47 percent, which directly lead to surgical volume growing by 24 percent,” said Rockman. “Another practice was able to more than double their MD team from 19 to 43 surgeons simply by implementing a uniform workflow that allowed them to scale economically. Other clients have used our software to quickly rebook surgeries cancelled due to unavoidable circumstances, thereby capturing revenue that would otherwise have been lost. In addition to the tangible benefits Surgimate delivers, it also improves the everyday working environment of thousands of doctors and staff by reducing confusion, stress, and friction.”
“Hospital IQ offers hospitals a cloud-based operations planning and management software platform that enables hospitals to leverage their existing data to improve the delivery of perioperative services,” said Jason Harber, Vice President, Product Management. “A leading hospital in Boston used Hospital IQ’s perioperative solution to enable surgical service managers to better manage and measure individual surgeons. Within two weeks, all of the hospital’s data was loaded and the hospital was ‘mapped’ in the data analytics system. Service managers have ‘dedicated views’ of their departments that allow them to monitor and manage services on a daily basis. OR managers share bi-weekly reports that accurately track performance and utilization. This shared accountability framework for both service managers and individual surgeons has led to volume increases and improved OR utilization. The hospital has increased OR volume by 3 to 5 percent annually, resulting in an incremental annual revenue increase of $3 million, without adding cost.”
Better building blocks
Today’s OR scheduling systems are clearly changing the way facilities organize surgical cases and can provide vast improvements across the board, especially when used properly and options are explored thoroughly to identify additional areas for improvement.
“Technology can help, or it can be a barrier; it is up to the team to ensure that process and technologies complement one another to facilitate accurate surgical scheduling,” said Kyle, AORN. “An example of technology coordination could be interface between scheduling software and physician procedure cards. Naming of procedures and selecting the appropriate procedure card can be extremely challenging for schedulers.”
Harbor added, “Once the technology is in place, leadership can look at new strategies, such as service line management, to appoint leaders to manage scheduling and drive volumes for each of their services. And it’s not just about discarding the old way of crunching data: leadership must have progressive views to engage surgeons and hold them accountable for their use of OR time.”
Kyle says facilities can also make collaborative efforts between stakeholders an enjoyable process in which traditional methods actually do continue to work well. “One organization scheduled quarterly breakfasts that included surgery schedulers, schedulers from clinics, and perioperative nursing leaders to address any changes to processes and to field questions from clinics,” she said. “This created a very collegial environment that literally brings key players together and was extremely helpful in humanizing teamwork among those who communicate almost exclusively via phone and email.”
Valerie J. Dimond | Managing Editor
Valerie J. Dimond was previously Managing Editor of Healthcare Purchasing News.
