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