While the average cost of operating facilities and surgical care varies widely, research has shown it can be as much as $36 to $37 per minute. In most hospitals, surgical services account for the largest cost, so OR inefficiencies quickly become the most significant revenue leak in the system. Similarly, OR efficiency can turn into one of the largest revenue generators.
Idle time between procedures, decreased case count, and patient no-shows are common causes of OR under-utilization. On the other hand, over-utilization can lead to staff fatigue and burnout, increased staff turnover, and case cancellations.
Careful management of OR resources through electronic data capture and process automation can prevent these undesirable outcomes. It lowers the average cost of OR time, which is a complex interplay of several factors in the perioperative process. For example, reserving the OR for too long or short a timeframe creates a scheduling nightmare leading to operational inefficiencies, prolonged wait times, and patient dissatisfaction.
Operating Room Efficiency Best Practices
Improving OR efficiency is a huge responsibility that involves multiple players — from patients, surgeons, vendors, assistants, anesthesiologists, to OR nurses. Everyone involved must contribute to cutting out or limiting inefficiencies in their roles. Optimum utilization can be achieved by some of these operating room best practices:
- Revising reallocations and block assignments
- Consistently monitoring turnaround times and making adjustments
- Monitoring case prioritization and adjusting accordingly
- Creating and documenting scheduling rules and revising as needed
- Establishing efficiency indicators, e.g., case lengths, delayed starts, and finding ways to reduce them over time.
A robust surgery scheduling software system helps prepare patients for the surgery, and, therefore, has a positive “downstream impact” on OR efficiency on the day of surgery. When healthcare facilities combine scheduling solution intelligence with other key data, major changes can be realized. For instance, by collecting data on key indicators like patient behavior (lateness or non-appearance), case times, delayed start times, reservation times, and even unpredictable events like emergencies to help decrease the unknown variables that often result in inefficiency.
Let’s examine four operating room best practices that can balance OR scheduling, OR utilization, and patient and staff needs:
1. Predict Patient Behavior and Compliance
Patient behavior is difficult to predict, and yet it is central to patient satisfaction and eventually revenue collection. A punctual patient will be dissatisfied if a delayed start time affects the start of their procedure. Conversely, a patient who does not show up/comes late wastes valuable OR resources.
In the latter case, the answer is far more complicated than simply instituting a waiting list. Instead, it may be helpful to collect data on patient behavior, and this individualized data becomes a more accurate predictor of a patient’s behavior. Using surgery scheduling software, you can track important patient metrics to predict behavior, and identify opportunities for improving patient compliance and timeliness on the day of surgery.
Research shows that case cancellations can be tracked by evaluating noncompliance with clinic visits or other health-based encounters. Are you looking at your surgical candidate's historical no show rate? Previously noncompliant patients should be scheduled for the end of the OR day so if an unanticipated cancellation occurs it won’t adversely affect workflow.
2. Reduce Non-Operative Activities
A considerable amount of OR time is spent performing non-operative activities, which can adversely impact OR efficiency. First, you must analyze costs related to OR resources and utilization. Supply costs directly impact the profitability of surgical procedures, and such information can be used to make staff more cost-conscious in their operations. Implementing operating room best practices can help to conserve supplies and equipment used for patient care.
However, equipment allocation is not the only variable that contributes to increasing time spent on non-operative activities. Consider these other activities:
- Room turnover time – time between patients’ procedures. The better-informed staff is about forthcoming surgeries, the more that can be done in preparation for the surgery in advance. Communication before the surgical day is key. Little if any time should be spent searching for supplies on the day of the scheduled surgery.
- Anesthesia induction – pre-operative patient prep including administration of anesthesia. Patients are nervous about surgery and particularly about the anesthesia they will be under. Providing insight about the type of planned anesthesia, and what to expect on the day of surgery can translate into much fewer questions and smoother sailing for nervous patients and overstretched staff.
- Emergency time – unanticipated delays from emergency occurrences during surgery which are inevitable.
Research shows that redesigning surgical processes through coordinated effort especially benefits short procedures (two hours or less) and progressively benefits medium-length procedures. With a surgery scheduling solution, hospitals and ASCs can employ data tracking for these variables, which can deliver incremental returns. For example, past data on a surgeon’s case duration or data on procedures’ average duration can help to optimize scheduling and decrease delays.
3. Optimizing OR Block Scheduling
In most hospitals, each surgeon is allocated a block of time 4 to 10 hours long for the surgical procedures he/she will perform. This must be accomplished optimally because under-utilized ORs cause financial losses to the hospital, while over-utilized ORs decrease patient and staff satisfaction, increase overtime compensation, and increase the chances of undesirable outcomes from procedures.
Surgery scheduling data can help to balance the need for surgeon block times with over/under-utilization of OR resources. Data on case durations and physician case averages can inform the optimal duration of reserved blocks for different physicians, in addition to normal variables in the hospital environment.
Block releases are critical to improving the flexibility of OR schedules. By building block releases into the block schedule from the outset, schedulers or scheduling software AI can add cases to underutilized blocks resulting from case cancellations or short procedure durations. Simply improving communication around block releases can enhance sharing of limited operating room resources and improve operating room utilization. Digital patient tracking tools can also help identify cases running longer than scheduled in real-time and reassign subsequent cases to under-utilized rooms where available.
4. Optimizing Equipment Availability
Using a pre-operative equipment checklist should be a standard among operating room best practices, and it should be handled by a dedicated pre-operative facilitation officer. This check can drastically improve first case on-time starts, setting the tone for a productive OR day. Surgery scheduling software can take this one step further by automating this process to mitigate the risks of human error.
Intelligent surgery scheduling software can even help to forecast potential problems in the following day’s scheduled cases by performing a pre-operative check for the large and small equipment required for previous checklists. During this check, the officer-in-charge may also ensure that technical issues with equipment have been resolved. If resolution is impossible during surgery scheduling, he/she should factor in the likely delay resulting from the use of sub-optimum equipment.
OR time should never be spent locating missing equipment or waiting for technical difficulties to be resolved. Except, of course, when such difficulties arose during the procedure and only if such difficulties were impossible to predict. Regular equipment maintenance can decrease the incidence of the latter.
Surgery Scheduling Software is Central to OR Efficiency
Surgery scheduling apps and software are more robust than simply capturing patient and staff details and assigning time block. CaseCTRL surgery scheduling was built by surgeons who understand the cost of OR inefficiencies and how to balance efficiency with staff and patient needs.
CaseCTRL helps simplify the complexities of surgical planning well before the actual surgery day. CaseCTRL is complimentary to your existing OR software and helps reduce the friction and challenges inherent to managing multiple operating rooms, staff, and surgeons with multiple variables. Want to learn more about how you can allocate resources judiciously, manage communications seamlessly, and even make scheduling changes in real-time according to arising circumstances? Get a demo of CaseCTRL to see it in action today.