Logistics Tool Makes Surgeons' Trains Run on Time

Like the rest of us, physicians aren't generally too enthused about their whereabouts being tracked—until they see what an OR control system can do for efficiency and hospital revenues.

What if a hospital could essentially guarantee that adding technology could help provide care at lower cost while at the same time boosting volumes in resource-intensive areas such as imaging and surgery?

Sound like a win-win? Hold on. It's complicated. Technology can be a great aid to efficiency, but it often comes with a nasty side effect—loss of privacy.

Like the rest of us who feel squeamish knowing that our cell phones can tell people where we are, physicians, generally, aren't too enthused about their whereabouts being tracked.

Until they see what a control system that employs tracking technology can do.

Expensive Delays
Bob Bonar Jr., Dr. H.A., who this month was appointed CEO of Children's Hospitals and Clinics of Minnesota, recently told me how technology boosted revenue and efficiency at Dell Children's Medical Center in Austin, TX, where he previously served as CEO.

After moving to Dell Children's in 2007, CEO Bonar noticed something he didn't expect to see at a brand new hospital—delays—and expensive ones, particularly in the OR.

"We were plagued by constant problems in the OR in terms of efficiency and effectively utilizing our ORs," he says. "It was sort of like the airline industry: If you have one bad weather event in one city, it reverberates all over the country."

Delays in the OR can cause a cascade of other delays that contribute to inefficiency, patient and physician dissatisfaction, and a host of other less-than-optimal outcomes. "You'd get them talking about this issue and some surgeons would say, 'I was there, but the room wasn't ready,' so there was a lot of finger-pointing going on," says Bonar.

It was maddening to everyone involved, especially because it was happening in a new, state-of-the-art facility, at least on the medicine side. In terms of operational efficiency, the hospital might as well have opened in 1987 instead of 2007.

'Why Can't We Track People?'
"While ORs contain multi-million dollar hi-tech equipment, most manage their workflow using very low-tech devices," says Bonar. Most hospitals still manage their patients, staff, and equipment with magnetic white boards, dry erase boards, or static screens, he says.

"When we were building the hospital, we looked at utilization of various tracking mechanisms. If we can track equipment, why can't we track people? But [the tracking tools] were all extremely expensive and they weren't fully integrated."

What Bonar needed was a way to track both equipment and personnel to get actionable information on where the bottlenecks were. He started casting around for help and found it in Tom Feo, who had developed tracking technology for the transportation industry and had been chairman of the mechanical engineering department at the University of Texas, right down the road from Dell Children's Medical Center in Austin.

"The more we talked, [the more] he was quite convinced the technology could be applicable to an OR," says Bonar.

Dell Children's was willing to serve as a testing ground for integrating the technology into healthcare. Similar problems had already been solved in logistics technology for transportation, he says, which is similar to the OR in that both must bring together numerous multiple resources together at one point in time.

By 2009, Dell Children's had installed an OR "control system" in its ORs and integrated it with the critical care units "so we were able to use the technology throughout the whole hospital," Bonar says.

There was some resistance from physicians at first because some of the surgeons didn't like the idea of administrators and schedulers knowing where they are at all times. (Physicians, and others, are tracked through RFID).

He credits them, however, with adopting the technology despite their misgivings.

Results
The investment has paid off handsomely. By February 2012, with the technology fully implemented and all users fully trained, the hospital had seen:

• A 20% increase in surgical cases
• An $11 million annual additional contribution margin to the health system
• A 35% drop in outpatient wait times
• An incidental finding of about $1.2 million in unbilled anesthesia fees
• Greater productivity and reduced anxiety physicians among physicians and care teams

"If there's one thing surgeons like, it's efficiency," says Bonar. Two other hospitals in the Seton Healthcare Family have since integrated the system, and two more are on the docket for 2015. 

"We ended up dropping about $125,000 [to install] the system and everything else we looked at was more than twice that amount and wasn't integrated," he says. "To be fair, that was early on, but we saved about 50% as far as the cost of the system."

One "really interesting" unexpected benefit was finding the unbilled anesthesia revenue.

"We had been doing this through manual entry of charges. I remember when I was a young department director, we'd stand out back by the ER and stop [nurses] to see if they left with yellow stickers they forgot to put on the card. That was what was happening," he says. "When you automate it, you don't miss the charges. It's that simple."

Bonar says hospitals should always be looking, to the extent possible, to try to take the human factor out of managing schedules. The schedule needs to "talk" to your surgeons and anesthesiologists without having to go through a human being. Eventually, such innovations will make the hospital a place where surgeons and other senior care team members want to work.

Additional Benefits
"To the extent you can improve the efficiency of your organization, you'll make yourself more competitive when you sell into networks," Bonar says. "That's particularly true of the children's hospital."

But it's also true of an adult hospital. The technology is now being used at Wesley Medical Center, a Wichita, KS-based HCA hospital licensed for 726 beds. Although the system just went live in early November, Matt Leary, the hospital's chief financial officer, is excited about the possibilities.

"This became a technology that we thought could help with improving turnaround and on-time starts and quickly realized how it could impact the whole perioperative line from the time the patient shows up," he says. "The anesthesiologists quickly began to have a lot of functionality to improve process and throughput in the OR."

Wesley has plenty of exponential opportunity to improve efficiency, says Leary, given that it operates more than 30 anesthesia locations and of those, 20 are ORs.

Like many hospitals, it struggling with getting good "optics" on when it could get the room turned around, and all the other variables, such as patient arrival, physician arrival, and anesthesia started.

"We could have really good turnarounds of 30 minutes, but sometimes it was 45–50 minutes," says Leary. "We should [have] around 25–30 minute turnarounds. We're shooting for an experience where for the doc and the patient, there's high reliability of start and end times."

He admits the technology can be perceived as pretty intrusive. "We're asking a lot of people tough questions. The great thing is we have a great relationship with anesthesia and they were alongside with us. This puts a very bright light on when and where things are happening, [in] real time."

"Right now, as the CFO, as I am able to look and see that a certain case started 15 minutes late, but the patient was here, we got them registered, it looks like the anesthesiologist did his check-off, so what happened? It really brings accountability at a high level."