When a patient sued Yale New Haven Hospital earlier this year for allegedly removing part of the wrong rib during surgery and then covering up the mistake, the case highlighted a problem facing operating rooms across America—avoidable human error.
Although the most egregious "Wrong-Site, Wrong-Procedure, and Wrong-Patient" errors are fairly uncommon, these and other more common preventable errors, including the wrong size tool being provided during surgery, do occur and are unequivocally problematic. Perhaps the errors do not even make their way to the patient, or mistakes are narrowly avoided by inefficient and unsafe mid-procedure halts to remedy missing or incorrect materials prior to being used.
Healthcare is in a continual state of flux. U.S. hospitals are under pressure to cut costs and become more profitable amid a wave of consolidation driven by private equity investors buying up hospital systems. Additionally, there has been a push by the federal government and private insurance companies away from the "fee-for-service" model of reimbursement—which incentivized clinicians for increased quantity of care—and toward "value-based care"—which aims to strike a better balance between cost, risk, and quality.
The operating room drives 60% of revenue in the average hospital. It is critical not just that avoidable human error be eliminated, but that heightened efficiency and quality of surgical care be driven more broadly. While technology has begun to enter the pre- and post-operative realms, little technology has been applied intraoperatively.
Technology is certainly embedded in our daily lives. Most of us use a GPS on our phone to drive from place to place and would be dismayed if we had to use a paper map. But many operating rooms—where getting it right is a matter of life and death, not merely convenience—use the equivalent of paper maps when it comes to organizing how the facilities work and how staff coordinate activities.
Imagine a surgeon having a patient open on the operating table for a gastric band surgery only to discover that the hospital does not have the specific surgical stapling equipment needed and having to send a nurse across town by car to another facility to get the equipment – all while the patient is under general anesthesia. Unfortunately, such horror stories are too common in U.S. operating rooms.
The good news is that hospitals have put substantial investment into the physical infrastructure of their operating rooms. Recently, some hospitals have upgraded their facilities with more sophisticated software for imaging and documentation, as well as hardware to enable robotic and minimally-invasive procedure. Doctors at Jersey Shore University Medical Center, for example, compare modern operating rooms to the difference between driving a modern Mercedes and a '56 Chevy.
However, there has been little attention focused on developing software to improve how operating rooms function.
Having a modern operating room is more critical than ever to create consistent quality across a variety of operative circumstances. Increasingly, surgeons are expected to conduct procedures in a minimally-invasive manner at dedicated and highly-specialized ambulatory surgical centers rather than hospitals, and to discharge patients on the same day. Ironically, the turnover of operating room technicians – who are under intense pressure but unfortunately not paid as well as the other staff in the room – can be as high as 30% annually, a contributing factor in team composition inconsistency. The end result is physicians who want things done a certain way have to work with an ever-changing cast of surgical team members.
The solution is incorporating modern workflow management software into operating rooms. Such software allows doctors to set their preferences for how the operating theater is set up, what equipment they prefer to use, and how they perform a procedure. No longer relying on analog guides pre-operatively, each member of the team can access a digital guide to those preferences in real-time and with multimedia.
The digital workflow software manages the procedure from pre-op through to getting the patient back to the ward. Information can include everything from videos about assembling equipment to instructions about which personnel will perform what role and when.
Last year, the average hospital had a profit margin of 4%, leaving little room for costly mistakes and inefficiencies. Driving efficiency during procedures can have a significant impact on a hospital's bottom line, increasing throughput during daytime hours, thereby reducing overtime, and allowing for increased case volume, particularly in instances where cases are short (such as in the interventional radiology suite).
Mission Health in North Carolina has been working to make its 47 operating rooms, the health system's biggest revenue generators, more efficient, offering a template for other U.S. hospital systems. Mission harnessed the power of computing and big data to put in place a series of technology improvements, including a computerized dashboard for visualizing turnovers, delays, and case volume.
The end result was stunning. Mission had a 20 percentage-point increase in the first surgery of the day starting on time. (As with airlines, where starting the first flight of the day late sets off a costly domino effect, hospitals must start surgeries on time or profit margins quickly evaporate.) The software also yielded an 85% reduction in staff hours required for data preparation and reporting surgical starts. Imagine if such data could be acquired and harnessed for comparison across institutions, particularly if that data were to capture staged progression throughout cases? The ability to recognize and eliminate costly and wasteful variability that neither improves patient outcomes nor drives revenue is a story that is just beginning to unfold.
Beyond those balance sheet benefits for hospitals, making operating rooms more efficient could produce medical advances too. In the coming years, as more operating rooms develop their own personalized digital playbooks for their best surgical practices, such information can be shared among physicians. That could result in better outcomes for patients and could possibly even lead to medical advances as doctors share innovations.
A July 2014 survey by Strata Decision Technology found 88% of hospitals had cost-saving strategies but that only 17% hit their targets. Adding technology to make our operating rooms operate efficiently would be a great place to start improving that outcome.
Jennifer Fried is the co-founder and CEO of ExplORer Surgical, a digital playbook for the operating room. Jennifer was previously a Bain consultant and healthcare venture capitalist. She is currently a Fellow in the Kauffman Fellows Program, a two-year program focused on venture capital and innovation.
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