Becker's Hospital Review

67 Executive Briefing Surgical Directions is one of the nation's industry leaders in clinical, operational and financial performance consulting, specializing in perioperative services. We also partner with hospitals to develop and implement organizational strategy, improve supply chain, and review workforce and staffing solutions. For more than 16 years, we have demonstrated our success with hundreds of hospitals nationwide, ranging from community-based hospitals to large academic centers. Sponsored by: "Many hospitals have a medical executive committee and a department of surgery, but neither party has much of a voice in how the hospital is run," says Ms. Torrance. "What hospitals need is a surgical services executive committee with surgeons, anesthesia members, administration and nurses. And administrators need to agree to defer to the SSEC on matters of the OR schedule." 2. Create logical and efficient surgical scheduling systems and processes. The Affordable Care Act has driven more hospitals to automate scheduling processes and incorporate them in the EHR. These automated systems include a surgical module to schedule procedures. In the past, surgeries were scheduled over the phone, via email, through fax, on paper or in-person. So many different pathways increased the likelihood of mistakes, according to Ms. Torrance. An efficient, automated system helps limit surgery schedule requests to one pathway as much as possible. Automated systems use a uniform document to collect patient data, minimize the likelihood of missing or collecting incorrect data, and provide access to the complete medical record at the time of scheduling. As test results are generated, they then migrate into the EMR. It is also important to schedule not only by procedure name, but also entering the CPT code. "When a case is scheduled incorrectly, the OR may not have the right name of the procedure, the necessary supplies or staff to operate, and it may end up having to delay or cancel a procedure," says Ms. Torrance. "Standardizing scheduling in a typed format, as opposed to a verbal format, can nearly eliminate mistakes, making the OR more efficient and productive." 3. Improve efficiencies. Efforts to improve OR efficiency start with the preadmission testing department. The PAT office is not frequently seen as a revenue- producing department, so many hospitals fail to dedicate adequate time, money, space and staff to this area. The PAT department collects information on a patient's medical history, current medications and any conditions the patient may have that would affect their surgical outcomes. The department also schedules any necessary medical exams prior to the day of surgery. According to Ms. Torrance, hospital executives need to understand that when PAT is done well, it can help increase on-time case starts, decrease turnover times, prevent case cancellations, reduce delays and improve procedure times. "PAT needs to take place at the front end of an episode of care, not on the day of surgery," she says. "When patients are properly prepped for surgery through the PAT department, they tend to have shorter stays and fewer complications and readmissions. Looking at these metrics, the ROI for a PAT department is clear." Hospitals can also improve efficiencies by updating surgeon preference cards for supplies and by sharing clinical metrics — such as case times — with surgeons and anesthesiologists. 4. Decrease anesthesia times in the OR. All too often, hospitals bring patients into the operating room just to have the anesthesiologist start their preparations — placing intravenous lines and set up critical monitoring lines and injecting surgical blocks — even though many of these things can be completed an a room other than the OR. Since the clock starts ticking when the patient enters the OR, anesthesiologists who prep patients in the OR end up lengthening case times. "Hospitals that develop block rooms or procedure rooms outside of the OR for anesthesiologists to complete their preparatory functions significantly reduce anesthesia times and boost efficiency," says Ms. Torrance. 5. Have specialty surgical teams assist procedures. Most surgeons specialize in certain areas of medicine, be it orthopedics, neurology, OB-GYN or other subspecialties. That said, nurses that specialize in one or two specific areas on top of their general surgical knowledge are assets to the surgical team. Specialized nurses who assist with the same type of procedures every day are more likely to be able to anticipate surgeons' needs and predict any situations that might arise with a given surgery. "Some small hospitals may not have the staff to create specialized surgical teams, but for larger hospitals and health systems with lots of resources, it just makes sense," said Ms. Torrance. Hospitals interested in training nurses in the OR typically use the Association of periOperative Registered Nurses' 101 course, design their own intensive six-month program or create a hybrid program. With a general course and some mentoring with specialty team leaders, most nurses can become a full-fledged member of the surgical team in one year or less, and then learn to become specialists. Because specialized surgical teams can improve case efficiency and surgeon productivity, as well as make nurses feel more knowledgeable, they can also boost surgeon satisfaction and nurse satisfaction. 6. Set a goal to have surgeons perform more than one case per day. When a hospital implements OR improvement efforts, most aim to make measureable progress. For instance, many hospitals aim to be so efficient that they can add an extra surgical case per day per room, Ms. Torrance explains. "The only way to know how far a hospital OR has come is to measure key performance metrics," says Ms. Torrance. "It's so important to set up key performance indicators and dashboards to capture an OR's baseline performance as well as every small step of progress. This data can help surgical departments set goals and show individual surgeons when their productivity is improving." According to Ms. Torrance, the hospitals that are most transparent with their data for on-time starts, case times and turnover times and the like are the hospitals that will succeed in improving surgical outcomes, increasing surgeon productivity and curbing outmigration.n

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