The following eight responses address the metrics operating rooms should use to measure efficiency and how often these measurements should be captured.
Q: How and how often should ORs measure their efficiency?
Mark Antoszyk, Chief CRNA, Carolinas Medical Center NorthEast (Concord, N.C.): Daily. At the end of shift or the beginning of the next day, with leadership involved, review what worked well or did not work well the day before with staff and the daily managers.
Houtan Chaboki, MD, Plastic Surgeon, George Washington Medical Faculty Associates (Washington, D.C.): Measure continuously. Examples include: actual start time for first case of the day vs. scheduled start time and turnover time between cases in each operating room.
Steven M. Gottlieb, MD, CEO, TeamHealth Anesthesia: Efficiency as a subjective measure often leads the OR team to address the wrong issues. The OR team — anesthesiologists, surgeons, nurses and administrators — should elect clearly defined objective measures such as first case start accuracy, turnover times, scheduling lead time, etc. Then they should establish specific targets for performance and quantitatively track their performance to those defined targets. Urgency and impact on quality, outcomes and financial performance should drive frequency [of measuring], but longer intervals may result in missed opportunities for improvement. Preferably, data should be tracked electronically for easy comparison and reports should include explanations for variance and action plans for improvement. Tracking within an acceptable standard deviation will reduce false alarms caused by one-time events.
Sue Kozlowski, Senior Healthcare Consultant, TechSolve: The ideal is always "real time" measurements that indicate where the process is flowing well and where there are barriers to that flow. In reality, most ORs don't have the capability to do this (they're too busy!). Many ORs monitor patient flow, census and staffing on an hourly basis. Other metrics, such as on-time case starts, room turnover time or block utilization can be measured weekly or monthly depending on need. A departmental team should review the available metrics and see how they connect to department or organizational goals to develop a dashboard of key performance metrics and determine how often they should be reported and reviewed.
Joseph Livengood, MD, Acute Care Surgeon, Medical Center of the Rockies (Loveland, Colo.), Biomedical Engineer, President, Livengood Engineering: OR managers should review their efficiency on a monthly basis and the data should be presented quarterly for committee/department review. There may be a number of committees and departments involved that should be familiar with this data.
The measure of efficiency in the OR should include two parameters: time and quality. Time is the primary measure of efficiency in the OR though filtering the time measurements of importance and identifying the dependent parameters can be more difficult. One such dependent parameter that is often mistaken as a primary parameter is the number of cases performed. The time parameters that will provide the best overall look at efficiency include: OR delays, average case time and turnover time. These are three simple measures that have widespread implications for many dependent parameters.
Efficiency must absolutely include a measure of adherence to the many quality protocols found in the OR. Time savings mean nothing if these protocols are compromised. The list includes: time-outs, pre-op antibiotics, instrument and sponge counts, medication reconciliation, etc. The goal for each of these is 100 percent compliance.
Adam McLarney, Director; Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, Senior Consultant, Blue Jay Consulting: Ideally, departments will measure efficiency and performance on a weekly or monthly basis. Implementing a department scorecard is the best approach for measuring performance. Typical metrics for the OR include: case hours, room utilization, turnover time, on-time case starts, productivity and overtime hours. Targets should be identified for each metric, and regular reporting should reflect current performance against these targets.
Catherine Munoz, BSN, RN, CNOR, LNCC, Director of Perioperative Services, St. Vincent Medical Center (Los Angeles): There are several data points used to measure OR efficiency, ranging from start time [to] turnover time, cancellation time and so forth. The use of electronic documentation can be a useful tool to capture every time-stamped event before, during and after a procedure. Over-dissecting efficiency and using too much information can confuse the goals. Keeping the measurement simple and focusing on the known problem areas, once identified, is a better method and easily translates to the working staff in setting new targets. Measuring on-time starts, cancellation reasons, delay reasons and "wheels in to wheels out" of each patient are good indicators to address purely operational issues without turning it into a research project. These simple indicators can be monitored weekly and monthly for the best snapshot of progress and hot spots.
Joe Smith, Vice President, Perioperative Care Division, Picis: Properly implemented technology enables management to measure OR efficiency on a daily basis, including OR turnover time, on-time surgery starts and OR utilization. In a manual environment, daily measuring of efficiency is difficult if not impossible, but technology-aided daily monitoring of OR efficiency can identify issues and behaviors as they happen and allow for more timely corrective measures.
The One Change ORs Should Make to Improve Efficiency: 9 Responses
NAPA Releases White Paper on Improving OR Efficiencies Through Perioperative Leadership
Q: How and how often should ORs measure their efficiency?
Mark Antoszyk, Chief CRNA, Carolinas Medical Center NorthEast (Concord, N.C.): Daily. At the end of shift or the beginning of the next day, with leadership involved, review what worked well or did not work well the day before with staff and the daily managers.
Houtan Chaboki, MD, Plastic Surgeon, George Washington Medical Faculty Associates (Washington, D.C.): Measure continuously. Examples include: actual start time for first case of the day vs. scheduled start time and turnover time between cases in each operating room.
Steven M. Gottlieb, MD, CEO, TeamHealth Anesthesia: Efficiency as a subjective measure often leads the OR team to address the wrong issues. The OR team — anesthesiologists, surgeons, nurses and administrators — should elect clearly defined objective measures such as first case start accuracy, turnover times, scheduling lead time, etc. Then they should establish specific targets for performance and quantitatively track their performance to those defined targets. Urgency and impact on quality, outcomes and financial performance should drive frequency [of measuring], but longer intervals may result in missed opportunities for improvement. Preferably, data should be tracked electronically for easy comparison and reports should include explanations for variance and action plans for improvement. Tracking within an acceptable standard deviation will reduce false alarms caused by one-time events.
Sue Kozlowski, Senior Healthcare Consultant, TechSolve: The ideal is always "real time" measurements that indicate where the process is flowing well and where there are barriers to that flow. In reality, most ORs don't have the capability to do this (they're too busy!). Many ORs monitor patient flow, census and staffing on an hourly basis. Other metrics, such as on-time case starts, room turnover time or block utilization can be measured weekly or monthly depending on need. A departmental team should review the available metrics and see how they connect to department or organizational goals to develop a dashboard of key performance metrics and determine how often they should be reported and reviewed.
Joseph Livengood, MD, Acute Care Surgeon, Medical Center of the Rockies (Loveland, Colo.), Biomedical Engineer, President, Livengood Engineering: OR managers should review their efficiency on a monthly basis and the data should be presented quarterly for committee/department review. There may be a number of committees and departments involved that should be familiar with this data.
The measure of efficiency in the OR should include two parameters: time and quality. Time is the primary measure of efficiency in the OR though filtering the time measurements of importance and identifying the dependent parameters can be more difficult. One such dependent parameter that is often mistaken as a primary parameter is the number of cases performed. The time parameters that will provide the best overall look at efficiency include: OR delays, average case time and turnover time. These are three simple measures that have widespread implications for many dependent parameters.
Efficiency must absolutely include a measure of adherence to the many quality protocols found in the OR. Time savings mean nothing if these protocols are compromised. The list includes: time-outs, pre-op antibiotics, instrument and sponge counts, medication reconciliation, etc. The goal for each of these is 100 percent compliance.
Adam McLarney, Director; Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, Senior Consultant, Blue Jay Consulting: Ideally, departments will measure efficiency and performance on a weekly or monthly basis. Implementing a department scorecard is the best approach for measuring performance. Typical metrics for the OR include: case hours, room utilization, turnover time, on-time case starts, productivity and overtime hours. Targets should be identified for each metric, and regular reporting should reflect current performance against these targets.
Catherine Munoz, BSN, RN, CNOR, LNCC, Director of Perioperative Services, St. Vincent Medical Center (Los Angeles): There are several data points used to measure OR efficiency, ranging from start time [to] turnover time, cancellation time and so forth. The use of electronic documentation can be a useful tool to capture every time-stamped event before, during and after a procedure. Over-dissecting efficiency and using too much information can confuse the goals. Keeping the measurement simple and focusing on the known problem areas, once identified, is a better method and easily translates to the working staff in setting new targets. Measuring on-time starts, cancellation reasons, delay reasons and "wheels in to wheels out" of each patient are good indicators to address purely operational issues without turning it into a research project. These simple indicators can be monitored weekly and monthly for the best snapshot of progress and hot spots.
Joe Smith, Vice President, Perioperative Care Division, Picis: Properly implemented technology enables management to measure OR efficiency on a daily basis, including OR turnover time, on-time surgery starts and OR utilization. In a manual environment, daily measuring of efficiency is difficult if not impossible, but technology-aided daily monitoring of OR efficiency can identify issues and behaviors as they happen and allow for more timely corrective measures.
Related Articles on OR Efficiency:
10 Experts Share the One Behavior They Believe Cripples an ORThe One Change ORs Should Make to Improve Efficiency: 9 Responses
NAPA Releases White Paper on Improving OR Efficiencies Through Perioperative Leadership