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Memorial Belleville Hospital
The Elephant in the OR: Reducing Surgical Case Time
Jeff Peters, MBA President & CEO, Surgical Directions Alecia Torrance, MBA, MSN(c), BSN, RN CNOR SVP Clinical Operations & CNE8/31/15
Issue2BUTCost per minute: $20 - $60Surgical Directions 2015Issue3BUTReducing case time is KEY to delivering strategic objectivesSurgical Directions 2015Objections No one should tell a surgeon how to perform a case.
This is interfering with the practice of medicine.
Our patients are more complex and sicker.
This will never work.4Surgical Directions 2015MorbiditySurgery duration is an independent predictor of complications, with a significantly increased risk above 3 hours. Although procedural complexity undoubtedly affects morbidity, operative time should factor into surgical decision making.
Hardy, K.L. Anesthet Surg J. 2014. 5Surgical Directions 2015ComplicationsBlood LossSSIsDVTsDeep Tissue InjuriesIncreased Pain
All leading to increased LOS and increases in readmission rates!6Surgical Directions 2015Getting StartedPhysician Champion
Information
Monthly Dashboard
Process Improvement
Leadership needs to both demonstrate change and address outliers!7
Surgical Directions 2015Physician ChampionPhysician Champion essential to reduce case time
OrthopedicActionChairman of Orthopedic Surgery12 joints per dayNational reputation
Commitment demonstrated by being in room for turn over
CardiacActionChairman of CV SurgeryCommitment demonstrated by review of case time by surgeon daily
Surgical Directions 2015Not sure what these slides are8
Process Improvement TeamMembers: Orthopedic LeadershipAnesthesia LeadershipNursingBusiness Development / Analytics
Goal:Identify opportunities to reduce case timeProvide transparent informationIdentify and remove barriersMonitor progressCelebrate successes
9Surgical Directions 2015Orchestrating Standard Work10
Designing Workflows11
Surgical Directions 2015Pre-Hospitalization WorkflowAnesthesia Driven Pre-Admission Testing (PAT) and Medical Clearance (optimization) Process:
Evaluation and testing 4 weeks prior to scheduled procedure
Anesthesia and medical clearance process aligned to minimize cancellations
ASA 1 and possibly ASA 2 patients may not require preoperative outside medical clearance other than going through PAT process via telephone
Chart completion 72 hrs. prior to scheduled procedure
Surgical Directions 2015
Pre-Anesthesia Testing
Surgical Directions 2015Day of Surgery WorkflowGovernance Surgical Services Executive Committee (SSEC)
Standard order sets
Electronic Dashboards
Daily Huddles with multidisciplinary teams
Defined roles and responsibilities
Parallel processing
Surgical Directions 2015
What is the Huddle?
H - HealthcareU - UnitedD - Daily (to make)D - DecisionsL - Leading toE - Excellence
PROBLEM/OPPORTUNITY LIST:
Recap of previous day Total cases for next day and 5 days out; PAT and scheduling completionReview of scheduleTotal number of anesthesia providers to start dayPAT problem reviewAntibiotics reviewReview Pending Action items
What Is POCU and Eugenia. We look 5 days out during business huddle. We do a morning business huddle with anesthesia leadership and OR leadership to look 5 days out to maximize OR efficiency and staffing. Afternoon operational huddle is with anesthesia, or leadership. PAT, clinical managers of each service, imaging, finance to review schedule next day15How to measure case timeSurgical Directions 201516
Case Time DataDriving Organizational ChangeSurgical Directions 2015Physician Scorecard
Surgical Directions 2015Physician Scorecard (contd)
Surgical Directions 2015OR Case Time Variance by Procedure20
Surgical Directions 2015Addressing VariancesTransparency of Data
Comparisons of Anesthesia Techniques
Comparisons of Surgical Technique
Observing Procedures
Crucial Conversations21
Surgical Directions 201510 Most Successful Techniques to Reduce Case TimeTurnover teamsAnesthesia Preference cardsReduction of items on Preference cards/StandardizationFlip room based on case volume and case timePA for complex procedures with technologyPAT ProtocolsDaily HuddleAnesthesia rounds on inpatients the night prior to surgeryAnesthesia agreeing on metricsLeadership addressing outliers22Surgical Directions 2015OutcomeSurgical Directions 2015Questions
Surgical Directions Information25For questions or comments, please contact:
Surgical Directions 541 N. Fairbanks CourtSuite 2740Chicago, IL 60611T 312.870.5600 F 312.870.5601
www.SurgicalDirections.com
Surgical Directions 2015Appendix: Notes for Slide 1226
Surgical Directions 2015