By Ginny Halloran
At the very best hospitals across the nation — hospitals that serve as benchmarks for others — only about 80 percent of the day’s first surgeries start on time.
Delayed starts for surgical procedures pose a classic hospital problem that’s related to the complexity of scheduling. With operating room time running upwards of $21 per minute at most hospitals, these delays also present a costly healthcare problem nationwide that makes inefficient use of medical resources including money, personnel and time. But even more importantly, these OR delays negatively impact patient care, says Laura Phieffer, medical director of Perioperative Services at Ohio State’s Wexner Medical Center.
“Ensuring that procedures start on time is at the heart of the patient experience. Our goal is excellent care, which means delivering care in a timely manner, meeting patients’ expectations and lessening the anxiety of patients and their families,” Phieffer said.
Phieffer and Armin Rahmanian of University Hospital Administration saw the delay in OR starts as a challenge that could be addressed and improved upon.
Mindful of the 80 percent on-time start record at the nation’s top hospitals, Phieffer and Rahmanian set the on-time start goal for University Hospital’s 22 ORs at 90 percent. “It was a bold, audacious goal,” Phieffer said.
Meeting that 90 percent on-time start goal — which the University Hospital team accomplished after an intensive 15-month effort — seems even more audacious after Phieffer and Rahmanian point out that in November 2011, University Hospital ORs had just a 55 percent on-time start record. Patients and staff benefitted from the turnaround, and the cost savings can be used for other needs. The 22 ORs went from delays of 4,000 minutes monthly to fewer than 800 minutes, an annualized savings of more than $800,000.
The turnaround began in late 2011, when on-time OR starts became a University Hospital priority ready for scientific scrutiny. Medical Center leadership, including Ronald Harter, Anesthesiology, and E. Christopher Ellison, Surgery, encouraged the initiative.
“There’s great value to having an embedded process improvement person, one who’s specifically trained and integrated into the leadership team and who can look at problems through an objective, scientific lens,” Rahmanian said.
The OR team turned to a process improvement program referred to as DMAIC: Define, Measure, Analyze, Improve and Control. Coincidentally, anesthesiologist Josh Lumbley was working on his Master of Business Operational Excellence at Ohio State’s Fisher College of Business as the OR process improvement began. He joined in the effort, using the experience as part of his capstone project.
As the team began defining the complexity of ensuring the day’s OR procedures start on time, several key issues rose to the surface, including standardization, removing barriers through better communications and accountability. Coordinating efforts among units helped standardize the gathering of patient information, a move that increased patient comfort and convenience as well as efficiency. Patients were no longer asked multiple times for the same information, helping reduce patient time in the pre-operative setting from 60 minutes to 45 minutes.
Communications and teamwork
“OR situations are fluid and dynamic,” said Phieffer, explaining that staff and support services sometimes need to be on standby to assist in difficult cases. “We began using our electronic medical record, IHIS, as a tool to alert surgeons and other team members about a patient’s condition and the likelihood that they would be needed in the OR, allowing us to avoid preventable delays,” said Rahmanian.
More emphasis was placed on recognizing the importance of teams and individuals performing their duties as expected and in a timely manner. The OR team met with members of each area that interacts with the OR. Discussions centered on each unit’s role, what was expected, and how to communicate expectations and improve service.
Scheduling, transportation, pre-op services/testing, central sterile supply, nursing, anesthesiology and surgery were among the areas that contributed to this success, said Phieffer and Rahmanian.
As the University Hospital OR team celebrated its achievement — 90 percent OR on-time starts for April 2013 — members began to focus on sustaining improvements and applying the same process to turnover time between surgical procedures.
Once again, these improvements support patient quality and safety goals as well as additional cost savings. Greater efficiency means that this money, personnel and time can be put to use elsewhere in the Medical Center.
Rahmanian says taking University Hospital ORs from 55 percent to 90 percent on-time starts in 15 months offers a model of how to achieve success: “Improving OR start times is a classic example of senior leadership having vision, giving support for a team approach, providing the right resources to do the work and achieve the goal, and then helping sustain this success in a transformative culture based upon accountability and excellence.”