When it comes to improving hospital productivity, operating rooms are of top priority.
Consider the fact that surgeons are often some of your best-paid specialists and that a single surgical procedure can pull dozens of hours from physicians, assistants, and nurses. And that’s just the workload. Surgeries ultimately account for 48% of all hospital revenue.
Operating rooms are one of your most costly – and important areas of your facility.
Thus, any improvements made in your operating rooms can pay enormous dividends and yield the most impressive impact on your hospital’s bottom line.
Defining Operating Room Efficiency
The first step is tracking the proper metrics.
Considering the wide array of complex metrics available, measuring the correct metrics is key. Otherwise, all the data you’ll collect will be useless.
Real improvements are only possible if you have a comprehensive, structured process for comparing a variety of relevant metrics to diagnose problems and measure success.
Operating Room Efficiency Metrics
While there are standard metrics that are common throughout hospitals and healthcare facilities like wRVUs and hours, specific metrics are required for determining OR efficiency.
Operating rooms should be tracking and measuring:
- First case start times
- Case time
- Case cancellation rates
- Staffing costs
- Turnover times
- Patient outcomes
Operating Room Efficiency Benchmarks
Now we can get more granular on these metrics.
For instance, case time can be split into segments such as ‘patient in to incision’, ‘surgery’, and ‘close to patient out’, to capture a more in-depth picture. Like this example in the chart below, you’ll be able to capture exact times of each stage of a surgery.
(Source: OR Manager Inc.)
Perioperative managers and directors are under pressure to make the most of any resources and achieve optimal performance. To succeed, this example of precise metrics is necessary to benchmark OR performance.
After all, you will not be able to find case time inefficiencies if you are not tracking each stage.
Operating room management entails:
- Identifying capital equipment needs and efficient operating room inventory management.
- Making management decisions on case scheduling and staffing.
- Personnel management.
- Championing observance of surgical standards and adherence to regulatory requirements.
- Maintaining efficiency of service specific staffing cases
Best Practices to Adopt in Your OR
1. Institute a Diverse Management Team
Before working on improving individual metrics, you need to build a support base for your operating rooms that will allow any new initiatives to thrive.
Enter a diverse management team that empowers every team member in the OR.
Your OR management team should include a variety of positions such as:
- Surgical services department chairs
- Anaesthesia services department chairs
- Perioperative nursing managers
- Quality and patient safety representatives
- A mix of senior-level surgeons and anesthesiologists
All these different positions and levels of seniority prevent operations from happening in a siloed vacuum.
Empower Your Certified Registered Nurse Anesthetist (CRNA)
Another position that must be focused on is your OR’s certified registered nurse anaesthetist (CRNA).
As we’ll continue to discuss in this blog, a significant roadblock in OR efficiency is time management. To get off on the right foot, you can place your CRNA in charge of managing the OR schedule and enforcing any quality initiatives.
Remember, a diverse management team empowers OR teams. This approach is designed to engage members of all levels in their work.
2. Check Supply Costs Against National Averages
The first metric to tackle is supply costs. Start by analyzing costs by procedure and by the surgeon. With these stats, you’ll be able to see what procedures are your biggest cost sinks compared to the national averages.
Without benchmarking your costs to national averages, you may be operating in a vacuum where a procedure that might seem cost-efficient to you and your surgeons, is actually costing 25% to 50% more than the average.
Once you have all the supply cost data, it is important to be transparent about it.
After all, you won’t be able to persuade your surgeons that they can be more cost-effective if they don’t see the proof. While this can be an awkward conversation, be sure to emphasize that you don’t want to change how surgeons are operating.
Instead, you want to work with your surgeons and entire OR staff to bring down costs in a way that does not impact the procedure in any way.
And by getting everyone involved in the conversation — from hospital management like a CMO, chairman of surgery, or OR manager to surgeons and other OR staff — you can all work together towards a common objective without stepping on any toes.
3. Improve Time Management
When the conversation about OR efficiency begins, time management is always one of the first areas that is brought up. And rightfully so, since any delay – let alone consistent delays – can domino into huge cost-sinks.
An example of tracking block time.
(Source: OR Manager Inc.)
Track Block Time
Recent research has suggested that block times should be adjusted based on a balance of under and overutilization, rather than the traditional method of being based on each individual surgeons’ utilization rates.
Striking a balance between the two can reduce the financial loss from underutilized ORs and improve OR staff satisfaction and happiness by decreasing the amount of overutilized cases.
Another suggestion is to plan for block releases that create a time slot where there is no procedure scheduled. This adds flexibility and the ability to add cases to blocks that would otherwise be underutilized.
Consistent Case Start Times
Tardiness in the OR is detrimental to efficiency, as even small delays in the morning can turn into large delays in the afternoon if everything is in turn pushed back.
According to research from the Stanford School of Medicine, a well-functioning OR will have cumulative tardiness of fewer than 45 minutes for every eight hours.
To bring your OR tardiness down to 45 minutes or less, here are some tips:
⦁ All patient medical records and necessary documents are prepared before case time.
⦁ Find the balance between not too early and not too late in regard to patient arrival time to ensure start time.
⦁ Create a system that ensures that anesthesiologists, surgeons, and any surgical case team member arrives on time.
Focus Your Turnover Time Efforts Elsewhere
Lastly, we must mention turnover time. For many hospitals, improving operating room efficiency usually includes finding a way to reduce turnover time.
However, several experts have found that this may not actually yield significant results.
Reducing turnover time between cases — i.e. trying to quicken processes such as sterilization — can just lead to added stress that could potentially impact patient and staff safety, which isn’t worth the minimal financial gain.
5 (Completely Avoidable) Current Issues in Operating Theatres
4. Reduce Gaps Due to Equipment Problems
Often delays happen because of equipment issues. Whether it be a breakdown of an important machine or simply misplacing equipment, these common delays can have huge impacts on case time.
To get ahead of these delays, take stock in every piece of equipment used in the OR. Whether you choose to organize this list by procedure or OR suite is up to you, but a list of equipment is needed nevertheless.
For example, is there equipment that is constantly breaking down during the same procedure? Do you discover at the last minute that equipment needs repairs?
Equipment problems can also be extended to inefficient equipment processes.
For instance, recent research suggests that overhead lights are being adjusted for every 7.5 minutes of overhead illumination during a surgery. Those adjustments add up, creating unnecessary delays during surgical cases.
Finding process inefficiencies can lead you down the road to simple solutions, like surgical headlights in the case of overhead light adjustments, that in turn can lead to increased efficiency.
5. Optimize Organization and Cataloging
Similar to equipment issues, organization issues can be a constant point of delay that affects start times and turnover times.
To combat OR organization issues, it is suggested that you catalogue micro-level inefficiencies.
It may seem minuscule but ensuring a piece of equipment that is standard throughout every OR suite is in the same place in each suite can help reduce OR staff stress.
You want your surgical teams to develop cognitive reflexes over where equipment is, and that won’t happen if every OR layout is different.
Additionally, the supply table organization is just as important.
While you don’t want to overly complicate a surgeon’s process with tiny OR configurations, you’ll want to work with your surgeons to find the optimal placement of the supply table during procedures.
Efficient operating room management demands not only good leadership but a flawless organizational structure and interdisciplinary collaboration. The process entails decision making on the distribution of resources, direction on roles and responsibilities, and frequent performance monitoring.