Who's Driving Your Surgical Schedule? Regaining Control and Improving Utilization
Background
A nine-suite operating room in a community hospital experiencing
gaps in their surgical schedule had significant challenges with
overall suite utilization and inefficient use of multiple other
resources. Poor utilization of resources such as labor, prime time
surgical hours, OR space, instruments, and equipment were the
direct result of an inefficient scheduling process. In order to book
surgeries into a surgeon's assigned block time, office personnel
would contact the surgery scheduling office directly to make
scheduling requests. As a result, surgery sequencing was then
driven by the surgeon office, the volume of patients scheduled
into the block and the order in which those cases are scheduled.
Approach
Partnering with Blue Jay Consulting and their onsite consultant, Operating Room, Pre-Admission Testing, Same Day Surgery, Sterile Processing and Anesthesia personnel sought a method to control surgical case sequencing by proactively planning and managing the next day's surgery schedule. Nursing, anesthesia and sterile processing personnel initiated a "Schedule Management Huddle" with the purpose of planning the next day's surgical schedule. The importance of engagement in and an understanding of the process change from surgeons and their office personnel were paramount. In the new process, patients would be assigned a procedure date but their arrival time and the actual procedure start time would not be determined until the day prior to the planned surgical procedure. The goal of the process change was to improve suite utilization and on-time case starts while reducing operating room turnover time.
During the daily schedule management huddle, the team examined patient readiness, to identify any barriers to first case on-time starts which may include missing cardiac clearance or extended anesthesia preparation. Next, group members examined the required equipment for each of the surgical cases. For example, cases in which laparoscopic instrumentation was required were sequenced back to back throughout the day in order to keep video towers and other equipment in the same room and prevent unnecessary movement in and out of operating rooms. Laterality of surgical sites was also considered to reduce the need to rearrange surgical equipment from one side of the room to the other. The group was sensitive to the need for instrumentation and instrument turnover and adjusted case sequencing based upon those findings. When a surgeon could be assigned a "flip room", surgeries were sequenced appropriately to ensure that patients arrived and were ready for transport to the operating room in time to meet the planned room start time.
At the conclusion of each daily schedule management huddle, the surgery scheduling office would review and verify the next day's surgery schedule with the surgeon's office. Following schedule verification, perianesthesia nursing personnel contacted patients to notify them of their arrival time, review medication administration instructions and NPO guidelines, along with any other pertinent instructions.
Results
As a result of this process change and proactive multidisciplinary case sequencing, first case on time starts improved from 70% to 77%. Operating Room turnover time was reduced 6 minutes per case. Elimination of gaps in the surgical schedule resulted in an improved overall suite utilization during prime time hours of operation from 61% to 65%.
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