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Executive Briefing: Improving OR Efficiency 44 4. Proactively avoiding gaps due to equipment problems. One best practice to avoid potential delays and gaps for missing equipment is to hold routine, daily meetings to forecast potential problems for the next day's caseload. For instance, are there any simultaneous procedures that may require the same piece of imaging equipment? Are any pieces of equipment experiencing technical difficulties or under repair? Identifying these problems ahead of time can help surgeons and their teams avoid a time-consuming setback in the middle of a procedure or block time. IVE PROCESS IMPROVEMENT Ensuring surgeons' preference information and cards are up to date can also help avoid potential delays. By regularly updating surgical preference cards, OR managers can help ensure case carts are thoroughly and precisely prepared for each procedure and clinical team. This saves OR time that would otherwise be spent looking for missing instruments, and it also reduces variable costs by reducing unused supplies. TOM LINE. J.D. Waldman, MBA, MD, professor of pediatrics, pathology and decision science with the University of New Mexico in Albuquerque and author of "Uproot U.S. Healthcare," says queuing theory can help OR managers plan for potential changes in volume, equipment utilization and other OR patterns. Queuing theory has to do with the mathematical study of waiting in lines, but it involves a closer analysis of resource allocation that can help OR stay ahead of demands. "You can use queuing theory to know what resources you need at 3 p.m. and what resources you need at 3 a.m., because those may be very different things," Dr. Waldman said. 5. Case start times. Tardiness in the OR is like a snowball rolling downhill. A morning case that begins 30 minutes late has repercussions for the entire day. The total length of tardiness grows larger as the day goes on, since the total duration of preceding cases increases. In his research, Alex Macario, MD, a professor with Stanford School of Medicine, found wellfunctioning OR suites have a cumulative tardiness of less than 45 minutes per every eight hours. ustainable operational s and culture change. erioperative changed the r more than ry academic nursing and fitability by To curb tardiness to less than 45 minutes per eight-hour block, OR managers should ensure patients' medical records and other necessary documents are available and complete prior to case start time. They should also determine when patients are told to arrive with precision — not too early, which can dent satisfaction rates, and not too late. Anesthesiologists, surgeons and other clinical team members should arrive on time, as tardiness on the providers' part can lead to dissatisfaction among the entire team. Finally, ordering surgeons' cases from most predictable to least predictable, and thereby the longest, can reduce the likelihood of cases running over schedule. 6. Controlling turnover times. Turnovers are different from delays, in that turnovers are less than one hour while delays surpass an hour. Still, lengthy turnovers are a source of significant dissatisfaction among surgeons, who see turnovers as lost OR time that could have otherwise been scheduled for cases. Consequentially, many hospitals focus on turnover time reduction to drive OR efficiency, but several experts and researchers say these improvements may not yield significant additional time at the end of the day. Furthermore, turnover time reductions can also signal unintended consequences related to quality. "Superhuman effort, for example, to rush around on the day of surgery trying to reduce turnover times may be dangerous, stressful and have little financial justification," Dr. Macario wrote in a 2010 editorial published in the Journal of Clinical Anesthesia. Dr. Macario also said costs associated with turnovers are only reduced if the hospital also reduces its OR allocations and staffing, which could potentially affect clinical quality, sterilization processes and patient safety. Instead, OR managers and clinical staff may be better served by focusing on same-day cancellations, on-time procedure starts, equipment availability and parallel processing to increase efficiency. n 10 Latest OR Expansions H ospitals across the nation are building and expanding their operating rooms in order to increase their capacity. Here are 10 of the most recent OR expansions. Barnes-Jewish St. Peters (Miss.) Hospital has begun the first phase of its multi-year renovation, which anesthesia staffing two 600-squareQ RN and includes the addition of models foot operating rooms. Q Profitable incremental OR volume Beaumont Hospital, Royal Oak Q Improving OR leadership (Mich.) opened the Suzanne & Herbert Tyler Center for Cardiovascular Interventions, which features a 1,600-square-foot hybrid operating room. ve Services as well as tell you about milar situations. Contact us to schedule nd design a path to operational excellence! om line through improved quality outcomes, vement. caldirections.com Concord (N.H.) Hospital completed an $11.6 million renovation, which features two new operating rooms. Keesler Hospital, part of Keesler Air Force Base in Biloxi, Miss., opened a $55 million patient tower that includes two new operating rooms. Fresno (Calif.) Surgical Hospital rebuilt five operating rooms as part of its two-year reconstruction project. North Oaks Medical Center in Hammond, La., unveiled a $95 million expansion, which features 14 operating rooms. Hammond-Henry Hospital in Geneseo, Ill., added a third operating room as part of its recently completed $22 million construction project. St. Luke's Hospital in Kansas City, Mo., opened a neuroscience institute that features four neurological operating rooms. Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., opened the Hoag Heart & Vascular Institute, which includes three cardiovascular operating rooms. Via Christi Hospital in Pittsburg, Kan., broke ground on a 40,000-square-foot surgery center that will include five operating rooms. n Surgical Directions is the nation's premier surgical services consulting firm. We are led by nationally recognized anesthesiologists and surgical services professionals who passionately help our clients improve their perioperative services through operational and cultural transformation. The Surgical Directions team provides hands-on assistance in organizational design, strategic planning, scheduling optimization, materials and instrumentation management, information systems design, staffing, OR management, physician relations, anesthesia negotiations, and revenue cycle management. Over the past decade, we have successfully helped more than 130 hospitals increase surgical volume, improve surgeon and patient satisfaction, decrease costs, implement perioperative growth plans, and enhance overall perioperative and anesthesia performance.