Implementing Systems to Track and Measure Surgery Scheduling

Another day at the OR ended with a canceled surgery. Why? The first case didn’t start on time. Patient 2 was set up for surgery on the wrong side. Patient 3 had complications that resulted in a two-hour delay. Patient 4 had to be rescheduled for two months from now. Several hours of OR time were lost.

How can you judge the systemic causes of inefficiency apart from the anomalies? Surgery scheduling software offers one version of truth for all data that flows through the schedulers’ hands each day.

In contrast to the old, manual paper-based surgery scheduling process, which leaves no way to audit and improve performance, surgery scheduling software is a hub for almost all activities that affect surgery volume and key KPIs.

If you can track and audit documentation and communication, you’ll gain clarity to make crucial process improvements. Let’s take a closer look at how this works.

Help Prevent Cancellations

Same-day cancellations can be demoralizing for staff and patients alike. In an eight-month study of 5,929 surgical cases, 4.4% were canceled day-of. 71.6% of those canceled were judged as potentially avoidable. That is consistent with additional research cited in the study. Potentially avoidable cancellation causes include the following:

  • lack of financial clearance
  • incomplete medical evaluations
  • patient not showing up
  • OR behind schedule

One of the key attributes of surgery scheduling software is the ability to streamline documentation and communication while providing a record. If you have missing financial clearance, an interface can automatically remind you. Incomplete medical evaluations can be identified before surgery time, reviewed from any device. Patient communication can be automated with read receipts so that they are aware of the financial obligations.

Reduce Turnover Time

Turnover time is a major KPI for ORs because it is largely controllable: it’s simply a matter of wheels out to wheels in for the following case. The predictable variability occurs due to different cases, their equipment, and clean-up needs. Experts suggest room turnover averages 25-35 minutes but can be driven as low as 12 minutes. While so much emphasis is placed on day of surgery events, in fact, to really optimize turnover time, it takes a concerted effort to organize cases in the days leading up to surgery.

Turnover challenges can be better understood with surgery scheduling software: just think about factors that affect room setup and readiness:

  1. Was doctor preference information available? Missing doctor preference information can create logjams of equipment and personnel. Surgical scheduling software can store preferences by surgeon.
  2. Vendor delivery of equipment: Were equipment orders placed and confirmed in a timely manner? Did the vendor get the update for the equipment the surgeon added on the day before? Vendor communication can be streamlined with scheduling interfaces.
  3. Missing surgical notes: Notes about site-side adjustment and patient-specific arrangements are critical for quick turnover. This hospital reduced site/side discrepancies to zero using a real-time database.
  4. Staff communication: Having staff out of place or having to scramble for paper-based information affects turnover. Phone calls and redundant communication can be replaced by AI-powered software.

Track and Improve Block Utilization

Block scheduling helps ensure that each specialty can consolidate cases on one day (or any smaller block unit) in order to maximize efficiency and resources. This does place the responsibility on the scheduler to sequence cases to best use OR resources.

Are you monitoring block utilization and achieving the industry goal of 75-85% utilization?

Many practices find it difficult to reign in wasteful blocks because the surgery scheduling process is shrouded in mystery. However, surgery scheduling software helps schedulers and surgeons focus on what is most important. The first step is streamlining and documenting communication with surgeons’ offices. Often, surgeons' offices fax handwritten notes that have to be interpreted or scanned and uploaded manually into the OR system. Using paper documents can make legibility an issue and can also leave scant space for notes and special arrangements. If physicians don’t have access to the surgery scheduling system, they may be apt to miss double-checking the details for the planned surgeries.

The managers at Illinois Sports Medicine & Orthopedic Surgery Center deemed verbal scheduling requests altogether too risky. They now require surgeon’s offices to use an electronic scheduling form. An advantage of scheduling software is that it can automate communication about patient demographics, insurance, procedure information, and special instrumentation.

The next priority is accurately scheduling cases: Why would a block not be accurately filled? Most surgeons underestimate total case duration because of the complex perioperative factors involved. To further complicate the scheduling picture, some surgeons calculate their times differently—time in the room vs. just surgical time. It often falls on schedulers to become aware of these inconsistencies, but surgery scheduling software provides data about estimates to all stakeholders, making the scheduler’s knowledge transparent to all.

It may be the surgery codes themselves causing the problem that lead to poor utilization. Scheduling software allows you to audit and reconcile codes for accuracy so that you are not stuck in the past.

The last key to block utilization via scheduling is filling open time blocks. Open time is critical for managing emergent cases and padding against unforeseen schedule changes; in fact, some experts recommend 20% of time be allocated to an open block.

Like any other block, the open block needs to be filled, or it is simply lost revenue. Phone calls are an inefficient way to dole out open time. Surgery scheduling software can create one place for surgeons to be made aware of open time and submit requests. The software can also help your OR enact a fair way of deeming which cases gain priority.

Improve First Case Start Times

How are your first case start times? The cases placed first are already usually the most complex, so starting off in the hole almost ensures the rest of the day will be threatened. On average, a common case is delayed for 28 minutes (turnover notwithstanding), and one study reckons this costs the ASC $1,043 each time it happens. Drift resulting from a slow first case start is largely avoidable: a good goal is to have 90% of first cases starting on time.

Many common reasons for first cases starting late can be avoidable. When the anesthesiology team receives inaccurate information about the surgery, it may not be recognized until minutes before the scheduled start when an assigned anesthesiologist reviews the case. For example, an unexpected regional block for anesthesia requires mobilization of resource, expertise, and supplies at last minute notice. Missing patient authorization and insurance forms create an unexpected burden and pull staff from the task of preparing patients for surgery. Likewise, absent testing documentation often leads to time-consuming last minute scrambling with phone calls and faxes to doctors’ offices that may not be open as early as the surgery center. These are typical pitfalls of manual processes.

The most common causes of patient no-shows are “forgetting about the appointment,” “patient scheduling conflicts,” and “miscommunication,” according to this scholarly source. Automated telephone reminders have been shown to reduce no-shows from 20% to 7%. Surgery scheduling software goes much further, keeping a record of contact, read receipts, and automated delivery of tailored messages to patients.

What's more, scheduling software can analyze case risk by inputs and help the scheduler make the best choice for the first case. This data can be reviewed periodically to determine if the scheduler should look for other tells as to which cases need to be scheduled first to stay on track.

Better Data, Better Decisions

Ultimately, you want to increase case volume and maintain quality outcomes. The scheduling process affects almost every KPI an OR monitors. Using surgical scheduling software consolidates communication processes and allows for richer messaging. It also creates one source of truth for the flow of cases, which is invaluable and actionable data. Start controlling what you can: learn more here.

Download the eBook: How to Improve Your Surgery Scheduling Process: A Comprehensive Guide

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