35 Elements of Operating Room Efficiency

Operating rooms are the proverbial heart of a hospital. Flow of patients through the OR impacts all departments from ED (Emergency Department) or ICU (Intensive Care Unit) and beyond. Surgeries are a major event in the lives of patients and their families and their experience in the OR a major driver of patient satisfaction.

Financially, ORs account for 40-70% of revenue for a typical hospital. They also represent a significant amount of investment (facility and equipment) as well as operating costs (staff, supplies, etc.). A well-managed OR can make all the difference in the financial stability of the organization.

This is why there is such an emphasis on running an efficient operating room at most hospitals. But what operating room efficiency metrics should you look at? How can OR leaders measure these metrics? What benchmarks can be used to see how an organization is doing?

At the highest level, OR efficiency metrics and improvements can be put into 5 categories:

  • Suite Utilization & Scheduling Accuracy
  • Pre-Admission Testing & Case Cancellations
  • Case Start Timeliness
  • Patient Out to Patient In & Close to Cut
  • Staffing

Suite Utilization & Scheduling Accuracy

KPIs (key performance indicators) or metrics to watch in this category are

  • Suite Utilization
  • Scheduling Accuracy
  • Average Inaccurate Minutes per Case
  • Unused Minutes
  • Delay Minutes
  • Add-on vs Scheduled cases

In order to improve on these metrics, you should consider

  • Daily Schedule Management Huddles
  • Guidelines for case scheduling accuracy
  • Modified block time with some first come, first served time
  • Minimum utilization threshold for block allocation
  • Release times based on specialty
  • Management of voluntary block release
  • Balance of cases throughout the week
  • Case times based upon historical data

Pre-Admission Testing & Case Cancellations

Surgical case cancellations are disruptive and costly. A last-minute cancellation disrupts the planned cases for the room, frustrates the surgeon and the staff, and wastes precious minutes of the operating room that could have been effectively utilized otherwise.

KPIs to watch in this category include

  • Percent of cancelled cases
  • Cancel reasons

Implementing proper protocols for pre-admission testing can have significant impact on these efficiency metrics:

  • Pre-registration process to expedite day of surgery flow
  • Pre-certification process to ensure reimbursement
  • Mandatory pre-admission processes
  • Telephone screening for low risk patients & surgeries
  • Streamlined diagnostic requirements based on protocols
  • Criteria for consults
  • Deadline for elective chart completion

Case Start Timeliness

All of your planning designed for efficiency in the operating room is thrown out the window if you are not able to start your cases when you had planned to. Some metrics to capture your effectiveness on this front include

  • First Case On-Time Starts
  • Subsequent Case On-Time Starts
  • After Hours Cases and Minutes
  • Delay Minutes

When designing improvement initiatives targeted at timeliness, it’s important to focus on the root cause of why cases are not starting on-time and putting resources and policies in-place to address them. Here are some elements to consider in order to improve case start timeliness

  • Start Time Matrix with clearly defined start time
  • Patient in room 5 minutes prior to posted start time
  • Room set-up teams
  • Dedicated support personnel
  • Root cause analysis to determine issues
  • Active governance structure to deal with issues

Patient Out to Patient In & Close to Cut

The time between when a surgery ends and when the next surgery can start plays an instrumental role in running an efficient operating room. Metrics that capture these times include:

  • Turnover Time – Room (Patient-Out to Patient-In)
  • Turnover Time – Surgeon (Close to Cut)

Understanding these metrics for your operating room can help you decide which one of the following improvement areas will have the biggest impact on your operations:

  • Proactive schedule management for case sequencing
  • Defined Patient Out to Patient In targets, by specialty
  • Defined criteria and effective use of "flip rooms"
  • Turnover teams for room clean-up and set-up
  • Communication between team members
  • Complete and accurate preference card and case carts
  • Appropriate instrument resources

Surgical Staffing Management

An important element of running an efficient operating room is how you manage your staffing needs. The impact of a well-staffed OR can be felt in all the metrics above. You can consider the following checklist for improving how staffing is done for your OR:

  • Defined hours of operation
  • Staffing pattern aligned with case demand pattern
  • Appropriate skill mix
  • Adequate room coverage
  • Compressed daily schedule to eliminate gaps
  • Surgeon, or service-specific teams
  • Prudent use of call teams

One of the most important element of efficiency optimization is knowing your metrics and being able to trend them over time. It is also important to get your metrics in a timely manner. If it takes your organization weeks or months to compile the data such that you can look at these efficiency metrics, by the time you and your staff review the reports, they have forgotten the context. It’s really hard to drive behavior change when feedback is more than a week old.

Having an automated and timely reporting system can make a huge difference in how effectively you can drive efficiency improvements in your OR. Utilizing the right operating room analytics software can help you achieve the type of improvements you want. It’s important that the software package you pick is both specialized for OR (gives you these important efficiency metrics) and can provide reports immediately (no delay between event and feedback). The Leap Rail Analytics application is designed from ground up to be your ideal partner in not only measuring your OR efficiency metrics but also in helping you achieve great improvements on these metrics.

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