Issue link: https://beckershealthcare.uberflip.com/i/430838
12 Executive Briefing: OR Optimization Pre-op optimization. Before, the OR used only loose guidelines for preoperative preparation. Patients often arrived in pre-op hold- ing with incomplete charts. Surgical Directions helped streamline Admission Testing Center processes and strengthen communica- tion. Team members along with anesthesia developed evidence- based pre-op testing protocols. Anesthesiologists and ATC staff developed protocols for identifying patients with obstructive sleep apnea and managing them postoperatively. Daily huddle. OR leaders established a short afternoon planning meeting to help ensure next-day efficiency. The "daily huddle" includes representatives from anesthesia, OR management and pre- and post-op nursing. "The huddle team reviews patient risk factors in order to manage care throughout the surgical continu- um," Ms. Weston said. "It also determines the optimal sequence of patients, assuring equipment is ready and available for sched- uled cases, which minimizes daily cancellations." Better OR processes. Surgical Directions worked with OR lead- ers to convert sequential steps to parallel processes through set- up, tear-down and post-op phases. Streamlined workflows helped improve patient throughput and also ensure strong cross-func- tional communication. Supply and inventory cost reduction. Several surgeons spear- headed efforts to standardize preference items within their ser- vice lines, reducing variation and supply costs. "Surgical Direc- tions also helped us develop a solid Value Analysis committee and negotiate with vendors more effectively to manage the supply expenses," Ms. Weston said. Safer surgery. Organizational silos prevented the strong commu- nication necessary for optimal safety. A task force guided by Surgi- cal Directions helped OR staff refine their "time-out" process using World Healthcare Organization guidelines. "We also strengthened policies and standards for surgical smoke management, infection control practices and massive transfusion," Ms. Weston said. In ad- dition, the anesthesiology medical director developed a lipid rescue kit, adding an extra layer of anesthesia safety. Strong outcomes These and other interventions helped Memorial achieve strong OR improvements in less than 12 months. Block schedule reform and other efficiency gains helped increase overall utilization to 63 percent. The OR is currently on track to reach its goal of 75-per- cent utilization. Higher utilization enabled the OR to move from a "horizontal" to a "vertical" schedule. Instead of opening 17 rooms daily, the OR now opens 14 rooms on Monday, 15 rooms Tuesday through Thursday, and 10 rooms on Friday. This has allowed Memorial to right-size the nursing staff, translating directly into lower labor costs. Nationwide, annual OR nursing costs are $250,000 to $300,000 per room. Memorial reduced staffed rooms by 19 percent overall, rep- resenting an annual labor cost savings of approximately $800,000 to $950,000. Higher utilization also enabled the anesthesia depart- ment to provide full coverage with a leaner staffing model. OR supply chain initiatives helped reduce direct costs. Physician- led work on preference items cut variation in preference card costs. In addition, contract renegotiations with Memorial's ortho- pedic implant vendor led to significant cuts in joint replacement surgery costs. Strengthening the ATC and adopting a daily huddle helped ensure more patients are prepared for their procedure on the day of sur- gery. As a result, the on-time start rate increased to 70 percent. Physicians appreciate the OR's more cohesive and standardized approach to preparing patients for surgery. In addition, improve- ments in OR communication and safety practices are helping Me- morial ensure optimal quality and patient outcomes. Memorial's OR transformation has positioned the hospital to target fresh strategic growth. Several initiatives are in place to increase orthopedic surgery referrals from primary care physi- cians. In addition, the SSEC is displaying strong commitment to the strategic success of the OR. Physician leadership is proving instrumental in the development of a Joint Replacement Center of Excellence. Trust and transparency Surgical Directions is led by active physicians. According to Ms. Weston, that was a key factor in Memorial's successful transfor- mation. "Dr. David Young from Surgical Directions is a practicing anesthesiologist, so he was able to develop a high level of trust and respect with our anesthesiologists and surgeons," she said. "He understands the workflow of the OR, and that spoke very loudly to our physicians." Ms. Weston appreciates Surgical Directions' collaborative ap- proach. "They worked side by side with us, and they sought our feedback. It wasn't just one-way communication." Chief nursing officers play a critical role in OR transformation. "As the CNO, I provided coaching and direction to project leaders on how to navigate organizational barriers," Ms. Weston said. "My role was also to monitor the progress of initiatives, make sure they stayed on track and re-direct them as needed." The key to dramatic OR improvement is full transparency, Ms. Weston said. "Unless your OR's weakness and opportunities are identified, there is no opportunity to truly transform operations." n Patricia May, BSN, RN, CNOR, is senior nurse executive, Bar- bara McClenathan, RN, BSN, MBA-HCM, CNOR, is senior nurse executive, and Dhir Desai is analyst at Surgical Directions, a peri- operative consulting firm that helps hospital ORs improve efficien- cy, financial performance, clinical outcomes, and patient and staff satisfaction. They can be reached at (312) 870-5600. leader in perioperative consulting offers or, central sterile leadership interim and permanent placements perioperative & anesthesia assessment · interim management 312.870.5600 www.SurgicalDirections.com STABILITY TRANSITION challenge of change leadership can be disruptive to any organization; critical forward improvements can be hampered or even stopped by the loss of At Surgical Directions, we believe finding the experienced your need is critical to making the transition to new leadership need support for current initiatives or to move in a new direction, professionals will help you meet your needs in a time of change. interim or permanent placement, we provide experienced, leaders. Our candidates are thoroughly screened and we match experience to meet the specific needs of your situation. Our proven make a seamless transition. interiM and perManent placeMents in: Services – Nursing Managers and Directors Services – Nurse Educators Services – Business Managers Processing Department – Managers and Directors provide you with leadership that will insure stability time of transition. during during Surgical Directions LLC is a national consulting firm based in Chicago that assists hospitals in improving the operational, financial, and market performance of perioperative and anesthesia services. Our consulting team is led by nationally-recognized, practicing anesthesiologists, surgeons, and surgical service professionals experienced in organizational design, block time, surgical scheduling, patient throughput, materials, staffing, strategic planning, and physician relations. Team members have successfully helped over 500 hospitals nationally increase surgical volume, improve clinical outcomes, improve surgeon satisfaction, improve anesthesia satisfaction, and enhance overall perioperative performance.