Society for Health Systems Conference February 20 21, 2004 A Methodology to Analyze Staffing and Utilization in the Operating Room

Transcription

1 Society for Health Systems Conference February 20 21, 2004 A Methodology to Analyze Staffing and Utilization in the Operating Room For questions about this report, please call Mary Coniglio, Director, VHA s Consulting Services at

2 Agenda: Review case study of Operating Room Assessment Provide project approach that can be duplicated back at the ranch

3 Consulting Approach: Shared consulting resource provides 600 hours of consulting per year Focus on process improvement and cost reduction. Dedicated staff for labor/process and for supply expense reduction Hospitals and consultants jointly select project areas Satisfaction and savings impact monitored after each project is completed

4 Project Background: Hospital administration requested consulting support because... Manual scheduling process. Surgeon s unable to get surgery slots when wanted Nursing incurring overtime while not being fully utilized during the regular hours Increasing number of add-ons to the schedule Delayed start time for procedures/difficulty locating surgeons Newly appointed VP Nursing wanted quantified review of the Operating Room not just anecdotal scenarios

5 Approach/Methodology: Conducted interviews. Reviewed existing data reports (not much available!!) Collected one month of case-specific data from the OR patient record to quantify room and surgeon times. Conducted data comparison with Solucient database Validated data and assumptions with managers. Prepared and presented report.

6 Project Objectives: Conduct an evaluation of the operating room (excluding supplies). Review current room utilization. Quantify individual surgeon use by time of day. Determine whether current block allocations are appropriate. Conduct external data comparison. Provide recommendations for improved processes. Develop data collection methodology to quantify surgeon and room utilization and to document delays on an ongoing basis.

7 FINDINGS: Delays: There were 107 documented delays. 23 cases,or 17% of the first cases were delayed greater than 10 minutes. The most frequent reason for first case delay was tied with between surgeon late and nursing. Operating Room Delay Summary First Case Delays Nursing 7 30% Surgeon Late 7 30% Anesthesia 2 9% Lab delays 1 4% Missing Consent 2 9% Other 4 17% 23

8 FINDINGS: Delays: 84 of the cases that followed were late. The two primary reasons for to follow cases to be delayed were, 49% nursing, and 23% the prior case was late. The nursing category is the default when a reason is not given. Delays less than 10 minutes are not captured. Operating Room Delay Summary All Case Delays Nursing 52 49% Prior Case Late 25 23% Surgeon late 12 11% Lab delays 1 1% Same Day PAT 1 1% Missing Consent 3 3% Anesthesia 3 3% Other 10 9% 107

9 Recommendation #1 Delays: Delays: Operating Room Further quantify the reasons contributing to nursing delay. Develop more detailed tracking form to better quantify why delays are occurring. Provide timely statistics to surgeons on average surgery time and delays. Address repeat outliers according to departmental guidelines. Consider to follow for a surgeon working within their block time when scheduling back-to-back cases. Quantify average case time per surgeon for top volume procedures to improve accuracy of scheduling.

10 Recommendation #1 Delays: Delays: Example Reasons. Patient Issues: Insurance problems, patient arrived late, patient ate/drank, abnormal lab values. Practitioner Issues: Needs more labs, incomplete/incorrect consent, physician arrived late, prolonged setup time, nursing short staffed. System Issues: Test results unavailable, blood unavailable, patient not ready on floor, transport delay, previous case ran late, equipment unavailable/malfunction, X-ray tech unavailable.

11 FINDINGS: Comparative Data: Use external database or trend internal performance... Comparative Data Review: Solucient Data Base Overtime Hours % of Total Worked Hours Worked Hours per OR Patient Worked Hours per OR Hour Salary Cost per OR Patient Salary Cost per OR Hour Supply Cost per OR Patient Supply Cost per OR Hour ** Concentrate on worked not paid hours **

12 FINDINGS: Staffing: Operating Room Comparative Data Staffing levels are FTE s higher than the comparison data base when compared on a per case basis. 50 th percentile is hours per patient. Staffing levels are FTE s lower than the comparative data base compared on a per hour basis. 50 th percentile is The hospital OR hour per case is 2.14 versus The time per case is high, while acuity is not, indicating there are patient throughput issues. Overtime as a percentage of total worked hours was 7.2%. The 50 th percentile is 3.2%

13 FINDINGS: Staffing: Operating Room Utilization There were three days in June when a room was not open due to lack of anesthesiology resources. Data was sorted by room by day to quantify utilization. Time between patient in room and incision is 33 minutes. Operating Room Utilization Information - By Day Date Day Room # Time IN Incision Time Time Between In and Incision Time Out Scheduled Time Case Time Surgeon 3-Jun Mon 1 8:18 8:30 0:12 8:52 8:00 0:34 MI 3-Jun Mon 1 9:11 9:21 0:10 9:45 Add-on 0:34 MI 3-Jun Mon 1 11:00 11:15 0:15 11:45 10:30 0:45 T 3-Jun Mon 1 12:10 12:40 0:30 13:05 Add-on 0:55 MI 3-Jun Mon 1 13:36 14:00 0:24 14:30 13:30 0:54 C 3-Jun Mon 2 7:45 8:04 0:19 9:34 7:30 1:49 S 3-Jun Mon 2 12:51 14:24 1:33 17:35 12:00 4:44 L 3-Jun Mon 3 13:20 13:48 0:28 14:45 13:00 1:25 MA 3-Jun Mon 4 20:45 21:00 0:15 21:40 Add-on 0:55 MA 3-Jun Mon 6 9:00 9:25 0:25 10:45 9:00 1:45 O'C 3-Jun Mon 6 11:00 11:27 0:27 12:10 10:30 1:10 O'C 3-Jun Mon 6 12:30 13:04 0:34 13:30 12:00 1:00 O'C

14 Findings: Room Utilization Review non-regular hour coverage and utilization to validate that the schedule hours are necessary. One hospital averaged a 5% night shift utilization rate. After Hours Room Utilization (Based on Staffing) Mondays Average Total Room Time in Minutes 82 Average Between Case Set-Up 30 Minutes/Case 30 Average Total Time in Minutes that Rooms are in Use 112 Staffed Room Time in Minutes (2.5 FTE's for 8 hours) 1,200

15 Recommendation #2 Staffing: Staffing: Operating Room Consider shortening the available hours for surgery on specific days to reflect actual hours being utilized. Avoid same hours each weekday mentality. Establish improvement team to determine why the time per case is significantly longer than the comparison. Revise staff start and stop times to coincide with actual surgery hours. Align staffing patterns to better meet surgeon volumes and practice patterns as determined by review of the block allocations, open times and utilized times.

16 FINDINGS: Block Allocation: Operating Room Only 3 surgeons have been assigned block time. Several surgeons without assigned blocks consistently use time. The block time allocation does not match actual surgeon practice. Block time utilization is not routinely monitored and revised to reflect actual practices.

17 FINDINGS: Block Allocation: Operating Room Operating Room Utilization Information - BY PHYSICIAN Dr. "M" Date Day Room # Time IN Incision TimTime Out Scheduled Case Time # of Cases Time Per Case 5-Jun Wed 3 12:45 12:55 13:20 11:30 0:35 7-Jun Fri 1 10:00 10:10 11:56 10:00 1:56 7-Jun Fri 1 17:45 17:54 18:55 Add-on 1:10 7-Jun Fri 2 14:45 15:08 16:55 14:00 2:10 10-Jun Mon 3 17:30 18:00 19:30 Add-on 2:00 13-Jun Thurs 2 16:00 16:21 18:45 Add-on 2:45 14-Jun Fri 3 7:47 8:00 8:30 7:30 0:43 14-Jun Fri 3 8:55 9:07 9:35 9:00 0:40 14-Jun Fri 3 10:05 10:39 13:35 12:00 3:30 14-Jun Fri 3 14:10 14:27 14:40 Add-on 0:30 14-Jun Fri 3 15:22 15:50 17:15 Add-on 1:53 17-Jun Mon 1 7:40 8:15 9:25 7:30 1:45 17-Jun Mon 1 9:50 10:15 10:45 11:30 0:55 17-Jun Mon 1 11:05 11:45 17:05 Add-on 6:00 24-Jun Mon 3 7:50 8:08 10:35 7:30 2:45 24-Jun Mon 3 10:55 11:22 12:30 10:00 1:35 24-Jun Mon 3 13:00 13:16 13:50 13:00 0:50 19-Jun Wed 3 10:46 10:46 11:30 10:30 0:44 32:26: :48:07

18 Recommendation #3 Block Utilization: Utilization: Operating Room Use actual surgeon time to revise current block allocations including additional surgeons. Adhere to established block rules. Consider changing block release time from 2 weeks to 48 hours to allow surgeons to schedule within their own block and not use open time.

19 Recommendation #3 Block Utilization: Operating Room: The following surgeons are recommended to have block time. Block Time Recommendations for Physicians - SUMMARY Based On Physicians Utilizing More Than 20 Hours in June 2002 Physician Monthly Hours Block Recommendation Block Hours Needed In to Out Monday Tuesday Wednesday Thursday Friday Per Week A 30:35:00 PM AM AM 7:38:45 B 25:11:00 AM AM AM 6:17:45 C 49:04:00 AM & PM AM 12:16:00 D 43:14:00 AM & PM AM 10:48:30 E 28:50:00 AM & PM 7:12:30 F 31:25:00 AM 7:51:15 G 23:22:00 AM AM 5:50:30 H 45:59:00 AM PM 11:29:45 I 29:20:00 No pattern 7:20:00 J 35:04:00 PM 8:46:00

20 Finding: Room Utilization Operating Room utilization ranges from 67% to 90%. Inpatient Operating Room Utilization Available Hours Compared with Utilized Hours Per Day Utilizated Hours Reflect Cases Performed Only During The Available Hours June 2002 Monday Tuesday Wednesday Thursday Friday Available Hours Total 4 Rooms Hours Used includes 30 Minutes Turnaround Unused Hours Room Utilization 84% 60% 79% 67% 90% Total for Month Average Per Day Average Case Time - Patient In to Patient Out Total Time Per Case - Includes TAT Projected Number of Additional Cases Projected numer of Cases Includes TAT

21 Recommendations: Increase number of cases by 52 per month. Summary of Revenue Opportunity Option I: Increase Surgery Volume While Maintaining Current Rooms and Staffing Adjustments to the block schedule and policy changes will give the department the opportunity to increase the case volume with the current staffing levels Additional Annual Cases * Additional Potential Net Revenue ** Main OR 624 $ 159,214 * Based on achieving utilization during 85% of total available OR time. ** Gross per minute charge $5.25 per OR minute. Potential Net Revenue calculated at 30% of gross charges.

22 Recommendation # 4 Room Utilization Operating Room: OR, flex staff schedules to reduce the number of FTE s by 2.6. Monday TuesdayWednesdaThursday Friday RN hours per OR hour Worked But Not Used Nursing H Total for Month Annualized Hours 5,388.3 FTE's 2.6

23 Recommendation Option II: Maintain Current Surgery Volumes and Adjust Staffing Requirements Excess Capacity in OR Hours per Day Worked Hours per OR Hour * Excess Worked Hours per Day Annual Excess Worked Hours Potential Annual Labor Expense Reduction ** Main OR ,388 $155,174 * Based on 50 th percentile of RN worked hours per OR hour for the national hospitals between beds compare group in the Solucient ACTION database, ** Includes benefit expenses estimated at 20% of payroll.

24 Recommendation # 4 Room Utilization Operating Room: Implement ongoing data collection method to concurrently quantify room utilization, turnaround time, and delays. Operating Room Data Collection SAMPLE Scheduled MD Arrived Anesth Room # In Anest MD Incision MD Out Procedure Staff TOT/Delays Time Holding Area Staff Time Ready Arrival Time Out Time 8:30 M Thornton/ 7:40 Vender 1 8:40 9:10 9:10 9:19 11:35 11:48 Carotid endartps/fb H&P needed 12:00 M Thornton/ 11:10 Vender 1 12:15 12:35 12:35 12:44 15:20 15:29 Carotid endartps/fb PC 7:30 G Thornton/ 6:50 Hanna 2 7:45 7:50 7:50 8:00 8:30 8:41 Bx. Bladder la DS Surg. Late 9:00 MI Thornton/ 8:30 Hanna 2 9:20 9:20 9:20 9:30 9:40 9:55 Exc. Arm masds/kb H&P needed/pc

25 Conclusion: Reduce Delays Improve Patient Throughput Reduce Schedule Downtime Staffing/Hours Adjustment Additional Case Volume Improve Surgeon and Case Scheduling??? Questions???