The operating room is one of the highest cost centers of a hospital—it can often account for more than 40% of an organization's total expenses. As a result, planners are exploring ways to improve OR efficiency by reducing high, unnecessary costs.
In response to cost pressure, Intermountain Healthcare looked at cumulative tardiness in their operating room schedule and noticed three contributing factors: first case on-time starts, case duration, and turnover time. As a result, the organization developed a three-pronged approach to increase efficiency and improve access for both surgeons and patients.
Intermountain changed the organization's definition of an on-time start by setting clear parameters for the times patients should be in and out of the operating room. These parameters explained to staff and surgeons the exact time they should be prepped and scrubbed in to the OR, which in turn reduced the delay period before surgeries from 7 minutes to 1 minute.
As a result of these changes, Intermountain improved from a 12% to a 68% on-time start rate within a three-month period. Keeping a consistent on-time start rate has shifted their surgeons' cultural mindset toward efficiency.
Tracking case duration for certain procedures allows Intermountain to enhance both surgeon and patient experience.
The organization shares OR times for specific procedures with its surgeons as well as the care duration variance—the scheduled duration subtracted from the actual procedure time. As a result, physicians understand the time required for the specific procedure relative to the time necessary for getting the patient in and out of the OR. Better tracking of case duration provides Intermountain's staff with more realistic expectations of OR access, and improves patient experience with a shortened wait time.
To improve turnover times in the OR, Intermountain re-assigned staff roles based on efficiency.
Initially, a lack of clear role-assignment was causing multiple staff members to perform redundant tasks, resulting in high labor costs. To resolve this, Intermountain used a "pit crew" methodology to assign roles. Realizing that certain tasks had to be performed in a staged order to maximize efficiency, the organization selectively identified individuals to fulfill each role based on efficiency rather than the person's title. While re-assigning these roles, a core set of nurses provided training for staff members who were assigned new positions. Intermountain was able to see a significant decrease in turnover time—for orthopedic procedures, the average turnover time declined from 27 to 23 minutes.
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