The operating room is a chaotic, ever-moving area of any hospital, an orchestrated dance between various physicians, technicians, nurses, administrators and patients. Brian Watha, director of process improvement for Surgical Directions, equated the OR to a symphony: It needs to be well conducted or it will sound terrible.
Mr. Watha discussed how examining certain data points can help hospitals cut through the chaos and "conduct" their ORs more efficiently and effectively during the Becker's Hospital Review CIO/HIT + Revenue Cycle Summit on July 21 in Chicago.
Five of the main indices he covered are listed below.
1. Cost of an OR minute. Time in the OR is extremely valuable and expensive. Mr. Watha cited information that the cost of an OR minute ranges from $75 to about $120, depending on the case. "So when I'm going through any process improvement, this is what I'm using to monetize my changes," he said.
2. Block utilization. Mr. Watha recommends using the best practice of 80/80 for OR blocking. In other words, 80 percent of the OR should be blocked with 80 percent block utilization rate. If 20 percent of the OR time is open, there is opportunity for growth, he said.
3. First case on time starts. Here, Mr. Watha used an airline analogy: "No money is being made if a flight is on the ground" or sitting at the gate between flights. Similarly, if the first case of the day in an OR doesn't start on time, it limits productivity and can negatively affect efficiency for the rest of the day. "Ninety percent of the time, if that first case is late, it's really hard to catch up," he said.
4. Room turnover time. Room turnover time suffers from a difference in definitions, according to Mr. Watha. Surgeons see that turnover is done the minute they walk out of the room, he said, even if a resident came in to close, for instance. When stakeholders don't agree on definitions, the validity of the data suffers. "The definition needs to be clear," Mr. Watha said, and all OR staff and surgeons need to be educated on what that definition is.
5. Day of surgery cancel rate. "Same-day cancelation is a killer," Mr. Watha said, as that time usually cannot be filled and then the OR is staffed for a procedure that doesn't happen.
Many of these points are directly affected by surgeon behavior, which is difficult for an administrator to change. That's where the data comes in.
"Who am I to tell a surgeon to show up? I can't tell surgeons anything," he said. "All I can do is audit them and measure them."
He added, "With data, [you] can hold people accountable."