For most hospitals, the operating room is like a double-edged sword. It accounts for a large portion of the operating cost, and inefficiencies in the OR can be particularly dangerous and costly. On the other hand, a well-run OR can be one of the biggest revenue generators.
Inefficiencies are often caused by underutilization or overutilization. Underutilization results in idle time before, after, or in-between cases, leading to decreased case count and lost revenue. Overutilization can result in case cancellations, staff fatigue, burnout, and increased employee turnover.
As such, managing OR utilization is key to optimizing revenue without sacrificing the patient experience. The good news is that there are small changes you can make that will make a big impact on your OR efficiency. It all starts with having the right data captured to facilitate change. Here's how you can optimize OR utilization:
1. Improve First Case On-Time Start
When first case of the day doesn't start on time, this creates a cascading effect that leads to delays and decreased efficiency throughout the day. A study titled Improving Operating Room Efficiency: First Case On-Time Start Project found that tracking relevant metrics, establishing embedded process improvement resources, and creating transparency of data can improve first case on-time start (FCOS).
For surgery to start on time, all the parties involved (e.g., patient, surgeon, vendors, assistants, anesthesiologist, and OR nurses) must be present. Pre-operative assessments should be completed, and OR equipment must be prepared. One study points to implementing a multistep operational plan to include a staggering start-time framework, coordination of stakeholder responsibilities, and a visual Stop/Go checklist to facilitate the process. Whatever method you choose, automating these functions within a surgery scheduling software system allows to the tracking and transparency you need to improve FCOS.
2. Implement a Pre-Operative Checklist
Having everyone and everything ready for each surgery can improve FCOS and ensure that every subsequent surgery can start on time. Make sure patients are prepared by reaching out to them proactively with automated communications before each procedure. The better educated and prepared the patients are on day of surgery, the less likely unexpected delays and questions are to occur. Implementing a pre-operative checklist in a preoperative appointment can also help improve FCOS substantially.
On the day of surgery, a comprehensive pre-operative checklist should include confirming the patient's identity and procedure, the presence of relevant assessments and test results, patient allergies, and the availability of anesthesia. It should also ensure that the surgeon, anesthesia professional, and RN circulator discuss anticipated critical events.
3. Minimize Delays and Case Cancellations
Cancellations on the day of surgery can have a substantial impact on OR utilization. These last-minute changes often don't allow enough time to fill the slots by rearranging the OR schedule — not to mention, any preparation that's already underway (e.g., opened supplies), which can add to the cost.
While not all cancellations are preventable, a surgical scheduling tool can help you coordinate the many moving parts to minimize the risks. For example, by sending automated reminders to ensure that everyone involved is present at the right time and using an intelligent repository to drive updated surgical preference cards can ensure required supplies and equipment are ready.
4. Collect Data and Leverage Analytics
Besides analyzing past delays and cancellations to extract insights, you should leverage data on physicians’ case averages when setting up OR schedule to improve the accuracy of the amount of time reserved for each surgery.
You can also use scheduling software that analyzes patient and case-specific risk factors to identify patients who can benefit from specialist pre-operative clearance to prevent last-minute cancellations. This can also help minimize complications during surgery, which could delay subsequent cases scheduled for the day. Collecting and ensuring all appropriate clearances are available can be laborious. Automating the management of these clearances can substantially reduce the chances one is missed.
5. Monitor OR Activities and Quality Indicators
Implementing a digital patient tracking tool can improve patient throughput. This can also help you identify procedures that are running longer than scheduled so that resources can be re-allocated and subsequent cases can be moved to other rooms if availability permits.
Also, it’s wise to establish quality indicators, such as delayed starts, block utilization, resource allocation, and case lengths exceeding block time allotment. Monitor turnaround time and track how cases are prioritized. With the data and insights, you can revise scheduling rules to improve efficiency and OR utilization.
6. Streamline Workflows and Procedures
To ensure the on-time start of every procedure, you need to capture the correct information at the time of scheduling. Minimize guess work and outdated preference cards by actively managing the supplies and equipment requested for each procedure.
You can also use surgical scheduling software to send automated notifications to coordinate everyone involved in each surgery with integrated, case-specific, and context-aware communications. Checking in with vendors, coordinators, surgery schedulers in advance of the scheduled surgery can catch many potential pitfalls. A study in the Pediatric Quality and Safety Journal found that sending surgeons automated text messages a day before a procedure with information on their first case, date, time, OR number, etc. helps improve FCOS.
7. Build a Time-Sensitive Culture
Any delay in the start of a procedure can create a snowball effect, resulting in OR delays for the entire day. Inefficient processes between cases mean that you'll need to allocate more time between procedures, resulting in fewer cases can be scheduled each day. The better the communication with the surgery teams in the days leading up to the scheduled day, the more likely there will be faster turnovers between cases, with more efficiently executed surgeries.
In addition to having all the patient records and supplies ready at the start of each surgery, you should define efficient workflows between OR procedures. This helps ensure that staff is performing their responsibilities within the allocated time leading up to surgery. In fact, one hospital improved FCOS by simply mounting a clock in the preoperative hallway to foster time awareness.
Pre-empt Risk Factors with a Comprehensive Scheduling Process
Inefficient communication and scheduling can result in bottlenecks and cancellations of surgical cases, causing unanticipated costs, inefficient patient care, and lost revenue.
Improving operating room efficiency needs to cover all the moving parts required for a successful operation (e.g., personnel, supplies, and equipment,) which can involve many departments and even outside parties.
Automate each step as much as possible to minimize errors and delays while ensuring that the right people get the correct information at the right time to optimize OR efficiency and utilization.
CaseCTRL is an AI-powered surgical scheduling platform designed to reduce canceled cases, scheduling conflicts, and supply issues so that your OR can handle more procedures efficiently. Schedule a live demo to see how we help you harness artificial intelligence and automation to improve and accelerate surgical care delivery.