Improving operating room efficiency is a critical component of healthcare process improvement. Hospitals across the country struggle with first case delays, prolonged turnover times, and inconsistent OR efficiency. This case study highlights how one hospital implemented structured healthcare process improvement strategies to significantly improve operating room efficiency.
The OR Team and the Orthopedic Surgeons were tasked to improve the First Case on Time Starts and the Turn Over Time. See how they did it.
Identifying Operating Room Efficiency Gaps
The OR Team and the Orthopedic Surgeons were tasked to improve operating room efficiency, specifically focusing on the FCOTS and the TOT. Historically the FCOTS was at 57% and the TOT was at 41 minutes. The causes for delays varied from supplies not being ready, instrument prep, surgeon delays, staff issues, environmental services, patient issues, anesthesia delays, and room preparation.
The team began the work by assessing the causes for every delay. It was found that there were many different things happening every day that led to a drop in OR efficiency, and not one cause was to blame for the low scores.
Next, the team watched the workflows closely and found a lot of variation around the amount of time it took to complete the exact same task when different people or variables were involved. This helped the team conclude that there was not a clear standard for how the unique workflows should be completed.
A Structured Healthcare Process Improvement Approach
First, the team developed new processes for how certain things needed to occur. This time they developed very specific steps for every process and included details such as who should complete the task, how long the task should take, and when the task should occur.
Next, the team met with the leadership teams that oversaw staff in the departments that worked in the OR such as EVS, Sterile Processing and Anesthesia and explained the findings and the recommended changes to the workflows. Together, the leadership teams provided staff education.
The healthcare process improvement education included:
• Why the change was happening
• What the change was
• Who is accountable for each step
• How the change will be measured
This was a very important step in their healthcare process improvement because it allowed the staff to ask questions and offer any insight the leadership team may have not considered.
The team then set a GO-LIVE DATE.
The process was trialed and every day they would all reflect on what worked well and what did not work well in improving operation room efficiency. The goal was to continue improving as a team and to regularly share feedback on the work, something they had not done before.
Sustainable OR Efficiency Results
Within a few months the hospital saw results from their healthcare process improvement: the FCOTS had improved to 76% and the TOT reduced to 30 Min. Over a period of several more months, the improvements in OR efficiency continued. Today, the FCOTS is at 87% and the TOT is at 28 Minutes. The results in operation room efficiency have sustained, which means that the OR Team and the Surgeons have successfully hardwired the new processes to improve.
The team has shared what made the biggest difference in operation room efficiency:
- clear communication
- continuous feedback on how they are doing
- clear, well-understood goals that helped each member understand their role in the process
Below is the actual email that the Surgeon Lead sent to the team just before the Go Live Date:
Colleagues:
Today at the Co Management Team meeting the following was finalized. In order to meet the goals, set it will commence, TOMORROW 01 FEB 2018. This information was discussed in the Orthopedic Section meetings and should not represent significantly new information.
First Case on Time start
PSI will occur at 0715 including surgeon, anesthesia, and OR nurse
Patient will have last bathroom at 0645
Surgeons and anesthesia need to arrive in time to complete all paperwork and consents prior to 0715
Plan is to move to room immediately following PSI (unless the room is not ready)
Compliance will be tracked
The OR has requested that the surgeons NOT call the room to have the staff there prior to 0715 as this will delay the process.
Turn Over Time
At the debrief during closing the surgeon, anesthesia, and OR nurse with set a goal time for the next PSI.
If the surgeon has departed prior to this and his PA is present, it is the PA/surgeon’s responsibility to communicate on the time that was agreed for the next PSI to ensure no disruption of flow.
The OR nurse will contact environmental prior to extubating to ensure they are outside the room to start turn over at wheels out of the patient
The OR team, environmental, and anesthesia have worked hard to streamline the turn over process
Breaks in this process will be tracked.
NOTE: PSI is the Patient Safety Interview and is conducted prior to the patient arriving to the OR. During the PSI the OR Nurse, Anesthesia, the Surgeon and the patient conduct a safety interview and focus on;
Right procedure,
Family or caregiver name and contact
Pertinent medical history that would increase risk
Allergies.
Next the Surgeon or other team member explains how the patient will be moved to the OR, that when they arrive staff will be working in the room to prepare for the procedure, equipment will be used to monitor blood pressure, HR etc. Medications that will be given and what to expect before, during and after the procedure. The PSI always starts 15 minutes prior to every case.
PSI is not required but is a best practice that can be considered as you work towards your goals
Copy of the actual dashboard at the beginning of YR 1
Baseline Level 1 Level 2
POPULATION CRITERIA: All first orthopedic cases between the hours of 7:00 AM and 9:00 AM in each room. The numerator is the count of first cases with a delay in minutes less than or equal to zero. The denominator is the total number orthopedic cases.
Emergency case in the room prior
February 2018 – July 2018
59% 75% 85%
POPULATION CRITERIA: All Orthopedic cases where surgeon is following themselves in the same operating suite. The numerator is the total number of minutes from wheels out to wheels in. The denominator is the total number of patients.
Parallel room cases
February 2018 – July 2018
41 35 30
This hospital had a baseline FCOTS of 59% and a TOT of 41 minutes as a baseline. Today they are at 87% FCOTS and 28 Minutes TOT
Actual Dashboard Following Implementation in Y1
59% 75% 85%
70% 68% 84% 73% 86% 76% 76% 76%
Level 2
41 35 30
34 34 38 40 39.73 36.5 30.46 30
Level 2
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