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OR Management: It's the Variability

Christy Dempsey, for HealthLeaders Media, May 21, 2009

Once the capacity requirement for this volume is known, space and staffing resources must be allocated to meet the demand. Establishing separate staffed capacity for urgent/emergent cases ensures that these cases have quicker access to the OR and that elective case volume is not bumped or delayed in order to accommodate the urgent/emergent volume. The separated flows thus allow better access to the OR, fewer delays, and more predictability for both urgent/emergent and elective volume.

Smoothing Elective Surgical Volume
The next step to improving flow is to smooth the flow of elective admissions into the hospital. One way to accomplish smoothing is to provide consistent OR block time by surgical service throughout the week based on OR utilization, as well as the patients' appropriate inpatient destination units. This requires accurate data on surgeon and surgical service utilization of the OR, and accurate and clinically-based admission and discharge criteria for the destination units for surgical patients. Data should also include accurate case duration times, defined as patient-in-room to patient-out-of-room time. Utilization is defined as case duration plus turnover time divided by the allocated block time or primetime as defined by the hospital.

While smoothing the available block time across the week is a start, the real path to sustainable smoothing of the elective admissions begins with understanding how patients are placed in the downstream inpatient units. By identifying the clinically preferred destination unit by service or physician, as well as the average length of stay for these patients, the hospital is better able to allocate both block time and inpatient beds to ensure that patients are placed in the most appropriate bed the first time and every time.

This is best accomplished with simulation modeling so that a variety of block scenarios can be evaluated in order to determine which scenario provides for the best utilization of the OR, as well as the best patient placement on the preferred inpatient units. For example, if general surgery and urology share an inpatient unit and the average length of stay for both services is 1.5 days, the OR manager and physician leadership should be careful not to schedule these services on the same days in order to assure adequate bed availability for all patients who require that inpatient unit.

Assuring adequate inpatient bed availability
Once the variability in the elective surgical volume has been smoothed and the urgent/emergent cases optimally managed, the hospital can determine its true bed needs. Using simulation modeling and taking into account the strategic goals of the organization, the hospital can effectively allocate the number of beds needed for areas such as medicine, telemetry and surgical service. This further assures that patients are placed in the right bed with the nursing staff best trained to care for them, thereby reducing length of stay, risk of error and adverse events and improving overall patient, physician and staff satisfaction.

Collaboration and Trust Prove Critical
Actively managing surgical volume will, at times, require some surgeons to change operating days or times, as well as office or clinic days, in order to smooth the surgical volume across the week. In order to make this work, a high degree of physician and hospital collaboration and trust are crucial. To help build that trust, the following are necessary:

  • Collecting accurate data and conducting analyses in order to ensure transparent and objective decisions
  • Encouraging trails to cement the collaborative relationship, address issues and enable rapid-cycle improvements
  • Making hospital leadership fully aware and urging them to be supportive of this initiative
  • Choosing the right physician champion
  • Having physician and hospital leadership work together to ensure that issues are heard, goals are established and progress is made
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This collaborative approach is the only method for implementing the smoothing strategy successfully. The gains in quality, patient safety, improved revenue, capacity and throughput are tangible and irrefutable.


Christy Dempsey, BSN, MBA, CNOR, is senior vice president for clinical operations at Patient Flow Press Ganey. She may be reached at cdempsey@patientflowtech.com.
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