Maintaining high-caliber efficiency is a fundamental practice for hospitals looking to contain high healthcare costs, improve clinical outcomes and maintain high levels of physician as well as patient satisfaction. All these factors contribute to a hospital's bottom line, so it is important hospitals are attentive to streamlining and making their facilities operate in an efficient manner, particularly in operating rooms. Here, Eugene Litvak, PhD, president and CEO of Institute for Healthcare Optimization, discusses three steps to improving and maintaining efficiency in hospital operating rooms and departments.
The Institute of Healthcare Optimization developed a variability methodology that was created to assist hospitals in streamlining patient throughput, the first version being published in Health Affairs. Bottlenecks in one area of a hospital could effectively cause bottlenecks in other areas of the hospital, particularly in relations between ORs and emergency departments. To resolve this problem, the variability methodology recommends a three-phase approach toward eliminating disruptions in patient flow.
Phase one — Smooth and separate patient flows. Because some ED cases are unscheduled surgeries and a majority of surgeries are elective, Dr. Litvak suggests complete separation of these patient flows, meaning performing those cases in different ORs. This allows to keep high utilization for scheduled ORs, thereby increasing surgical throughput. Simultaneously, this allows to have relatively low utilization of unscheduled ORs, thereby controlling the waiting time for emergency and urgent cases. By separating the beds and patient flow between ED and OR procedures, hospitals could also potentially increase throughput in each of these departments.
Phase two —Smoothing elective surgeries. Once phase one is done, hospitals should work to smooth their elective surgical volume through the week days, thereby preventing patients from coming to surgical floors or wards in clusters.
"The first step is to separate the apples from the oranges and use this methodology to measure how many beds are needed for elective procedures and how many beds are needed for unscheduled emergency procedures," Dr. Litvak says. "Based on the demand and time for varying types of surgeries, hospitals can determine exactly how many beds an OR or ED needs."
In order to do so, Dr. Litvak says a hospital CEO or administrator may want to ask each surgical subspecialty to work together and control how many patients are sent to the OR. "Operating as a team, rather than as individuals, helps settle the issue of competing for the same limited resources, such as the number of beds," he says.
This approach may cause some uneasiness among physicians who would rather send patients to the OR at the time of their choice. Dr. Litvak recognizes that many physicians may react to this suggestion with some resistance. However, he says approaching those physicians with data on the positive results yielded from applying the variability methodology, including decreased overtime, often assuages disgruntled physicians. "Of course, there is some physician resistance, but when you approach them with data showing that protecting their kingdoms isn't the best solution for them and their patients and present success stories, they often listen," he says.
Phase 3 — Estimate resource needs for each type of patient flow. Hospitals should be collecting and analyzing data and trends to see exactly what resources, such as the number of beds and staff, are needed for each type of patient flow. Given that the capital costs alone of adding one hospital beds exceeds $1 million, then conducting such on-going analysis ensures patient flows are cost-effectively being met with the appropriate needs.
"Only after one eliminates the peaks and valleys in patient flow, hospitals can answer the question of how many beds it needs for each hospital unit," Dr. Litvak says.
Dr. Litvak admits it may be a difficult challenge for hospitals to commence collection of such important data, however to evaluate return on investment from applying variability methodology, he suggests hospitals start with tracking three major characteristics of their ORs: surgical throughput or case volume, amount of overtime and waiting time for unscheduled surgeries. Hospitals should measure these three parameters and meaningfully use that data as a spring board to improve OR efficiency.
Another key consideration for data collection to improve efficiency is to include clinical staff in that process. Dr. Litvak says discussing with surgeons what tolerable wait times are for varying surgeries, for example, is crucial for ensuring a hospital's effort to improve OR efficiency without negatively impact patient outcomes. Obtaining physicians' input on tolerable wait times also allows hospitals to better gauge what resources are needed to carry out certain procedures in an efficient and safe manner.
Learn more about Institute for Healthcare Optimization.
Variability methodology
The Institute of Healthcare Optimization developed a variability methodology that was created to assist hospitals in streamlining patient throughput, the first version being published in Health Affairs. Bottlenecks in one area of a hospital could effectively cause bottlenecks in other areas of the hospital, particularly in relations between ORs and emergency departments. To resolve this problem, the variability methodology recommends a three-phase approach toward eliminating disruptions in patient flow.
Phase one — Smooth and separate patient flows. Because some ED cases are unscheduled surgeries and a majority of surgeries are elective, Dr. Litvak suggests complete separation of these patient flows, meaning performing those cases in different ORs. This allows to keep high utilization for scheduled ORs, thereby increasing surgical throughput. Simultaneously, this allows to have relatively low utilization of unscheduled ORs, thereby controlling the waiting time for emergency and urgent cases. By separating the beds and patient flow between ED and OR procedures, hospitals could also potentially increase throughput in each of these departments.
Phase two —Smoothing elective surgeries. Once phase one is done, hospitals should work to smooth their elective surgical volume through the week days, thereby preventing patients from coming to surgical floors or wards in clusters.
"The first step is to separate the apples from the oranges and use this methodology to measure how many beds are needed for elective procedures and how many beds are needed for unscheduled emergency procedures," Dr. Litvak says. "Based on the demand and time for varying types of surgeries, hospitals can determine exactly how many beds an OR or ED needs."
In order to do so, Dr. Litvak says a hospital CEO or administrator may want to ask each surgical subspecialty to work together and control how many patients are sent to the OR. "Operating as a team, rather than as individuals, helps settle the issue of competing for the same limited resources, such as the number of beds," he says.
This approach may cause some uneasiness among physicians who would rather send patients to the OR at the time of their choice. Dr. Litvak recognizes that many physicians may react to this suggestion with some resistance. However, he says approaching those physicians with data on the positive results yielded from applying the variability methodology, including decreased overtime, often assuages disgruntled physicians. "Of course, there is some physician resistance, but when you approach them with data showing that protecting their kingdoms isn't the best solution for them and their patients and present success stories, they often listen," he says.
Phase 3 — Estimate resource needs for each type of patient flow. Hospitals should be collecting and analyzing data and trends to see exactly what resources, such as the number of beds and staff, are needed for each type of patient flow. Given that the capital costs alone of adding one hospital beds exceeds $1 million, then conducting such on-going analysis ensures patient flows are cost-effectively being met with the appropriate needs.
"Only after one eliminates the peaks and valleys in patient flow, hospitals can answer the question of how many beds it needs for each hospital unit," Dr. Litvak says.
Dr. Litvak admits it may be a difficult challenge for hospitals to commence collection of such important data, however to evaluate return on investment from applying variability methodology, he suggests hospitals start with tracking three major characteristics of their ORs: surgical throughput or case volume, amount of overtime and waiting time for unscheduled surgeries. Hospitals should measure these three parameters and meaningfully use that data as a spring board to improve OR efficiency.
Another key consideration for data collection to improve efficiency is to include clinical staff in that process. Dr. Litvak says discussing with surgeons what tolerable wait times are for varying surgeries, for example, is crucial for ensuring a hospital's effort to improve OR efficiency without negatively impact patient outcomes. Obtaining physicians' input on tolerable wait times also allows hospitals to better gauge what resources are needed to carry out certain procedures in an efficient and safe manner.
Learn more about Institute for Healthcare Optimization.