Singapore Healthcare

8/13/2019 Singapore Healthcare

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BPR at Surgery Dept.Singapore Hospital

Camille Armand (193)

Abhijeet Kr. Sinha (001)

Amrit Pati (007)

Arnav Nandy (012)

Bikash Ranjan Sahoo (018)

Debadutta Patro (021)


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Introduction

Singapore Hospital department of surgery 21 operating theatres (OT):

- 19 for elective surgery (8h/day)

- 2 for emergencies (24h/day)

Daily reservations of the OT for a specific clinical discipline:

- some OT are exclusively reserved for some disciplines

- others free to be used by any other disciplines

The simulation is based on only 8 OT to make it simple (8categories of surgery)


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Overview of the problems faced by the

department of surgery

Rise in healthcare costs in the last 30 yearsrise in the department expenditures

Increase in the demand of surgery services in the last 20

years+ Lack of manpower in the sector (low doctor-to-patient ratio)

Each OT reached a high rate of utilization

the department has to deal with it and optimize its current resources to

improve the efficiency and effectiveness of the OT utilization+ they have to keep in mind to provide quality services


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Problems, possible solutions and outcomes

1. Elective operating theatres operate from 8.30 to 17.30. There are delaysdue to complexity of surgery or operational delays. Solution prescribed:Implementation of shift system

2. Each operating theatre was reserved for a specific clinical discipline.Solution prescribed: Declassifying the operation theatres

3. 19 of the 21 operation theatres were allocated for elective surgery. When

there was an increase in emergency cases, they needed to be scheduledin some other elective operation theatre thereby affecting the scheduling.Solution prescribed: Better scheduling system, More emergency operatingtheatres

4. Orthopedic surgery creates a bottle neck due to its high pre-operatingarea time. Solution prescribed: Model 3 with the declassified operatingtheatres.

As they reduce the wait time in the pre-operating area to 69%

from 90%. System efficiency also went up to 64.8%5. Specific surgeons with certain surgical specialties are highly utilized.

Same for the anaesthetists due to their work in the pre-operative and post-operative processes. Solution prescribed: collect data on a regular basisand review theatre utilization periodically


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O.T. PROCESS FLOWCHART

Arrival

Shift to

recovery cabin

Pre-Op

Surgery

O.T. Setup

Shift to O.T.

Summon to

O.T.


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Original Model

PATIENT STAFF (X) SURGEON (Y) ADMIN

RegisterSingleShift 0800-

1800 hrs

Approve

Schedule

Pre-Op

SetupExclusive OT

Arrive

Summon toExclusive OT

Shift on Gurney

to OT

Surgery

Exclusive OTs

Shift forRecovery

MiscProcesses

Exit


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Model #1

STAFF(X/2)

SURGEON(Y/2)

ADMINPATIENT

Register Approve

Arrive

Pre-Op

Setupspecific OT

Shift onGurney to

OT

Shift forRecovery

PATIENTSTAFF(X/2)

SURGEON(Y/2) ADMIN

Register Approve

Arrive

Pre-Op

Setupspecific OT

Shift onGurney to

OT

Shift forRecovery

Summonto OT

SurgeryExclusive OTs


Summonto OT

MiscProcesses

MiscProcesses

Schedule Schedule

Exit Exit


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ADMINPATIENT

Register Approve

Arrive

Pre-Op

Setupspecific OT

Shift onGurney to

OT

Shift forRecovery

PATIENT ADMIN

Register Approve

Arrive

Pre-Op

Setupspecific OT

Shift onGurney to

OT

Shift forRecovery

Summonto OT



Summonto OT

MiscProcesses

MiscProcesses

Schedule Schedule

Exit Exit

STAFF

(X/2+)

SURGEON

(Y/2+) STAFF(X/2+)

SURGEON

(Y/2+)

Model #2


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Discussion and Conclusion

The simulation model was run for 168 hours (7 days), with a warm-upperiod of 48 hours, with 20 replications

Locations : Entrance, Pre-Op, Recovery, Exit, Specialty OTs.

Resources : Gurney, Anaesthetist, Surgeon.

Specialty Operating theatres : Highly Utilized Specialty Surgeons : High Demand

Anaesthetists : Highly Utilized

Declassification of OT

Utilization of Pre-operating area reduced from 90% to 69%, i.e., bottleneck improved.

Efficiency improvement from 45.6% to 64.8%.

Total no. of Exits almost doubled.

Total number of failed arrivals reduced by 28%.


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THANK YOU

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