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Case Study

How LHSC shifted surgery volumes to Ontario’s first high-efficiency ASC

15 Minute Read

    Overview

    The challenge

    London Health Sciences Centre (LHSC), like many Ontario teaching hospitals, faced significant demographic, capacity, and financial pressures over the last decade. These pressures resulted in multi-month wait times for elective surgery, as well as for specialist surgical consults.

    The organization

    LHSC is a multi-site, public health system located in Ontario, Canada. It has a combined capacity of 1,000 beds across all facilities.

    The approach

    LHSC adapted a 10,000-square foot space into its new ambulatory surgical center (ASC). The ASC, called the Surgi-Centre, delivers select, low-acuity ambulatory surgical procedures on a strictly outpatient basis. It opened in March 2020, consisting of 2 ORs and 10 pre/postsurgical beds, with capacity to treat 8 to 15 surgical patients per day.

    The result

    LHSC's Surgi-Centre is the first ASC of its kind in Ontario, Canada. It has demonstrated 56% lower case costs based on human resources, disposables, and anesthesia costs for low-complexity procedures on low-risk patients at LHSC, while simultaneously expanding surgical capacity.

     

    Approach

    How LHSC took a deliberative approach to transitioning care from hospital to ASC

    Creating the Surgi-Centre allowed LHSC to shift low-intensity, low-resource surgical procedures from its main acute site to an ambulatory surgical center. LHSC accomplished this shift, maintained a high level of clinical quality and engagement among staff, and reduced surgical operating costs to the system.

     

    The three strategies

    LHSC’s site-of-care-shift from traditional, acute hospital to an ambulatory surgical center was achieved through a unique approach: ensuring quality by real-world testing the “shift concept” within existing sites of care, preparing physicians and clinical staff to operate in a new care setting through an audition-like process, and boosting staff engagement through an “entrepreneur-oriented” approach to operational feedback.

    • Strategy

      Test operational aspects of proposed shift within existing site of care

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    • Strategy

      Audition clinicians to ensure they can deliver equally high-quality care within the limits of the new setting

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    • Strategy

      Foster a culture of “innovation authority” to enable continuous improvement of new model of care

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    Results

    How we know it’s working

    The goal of the Surgi-Centre was to simultaneously help LHSC expand capacity, cut surgical wait times, and dramatically reduce surgical costs, while improving the patient experience.

    • Expanded capacity: The Surgi-Centre has a forecasted surgical capacity of 2,400 per year. The model has been so successful that there is active discussion about creating additional capacity at the site.
    • Complete shift of certain surgical procedures: Certain surgical procedures are now conducted exclusively at the Surgi-Centre, freeing up capacity within acute-site ORs. Examples are listed below.
      • Orthopedic trauma: foot and ankle
      • Sports medicine: Knees and shoulder arthroscopy as well as knee/shoulder ligament repair, tendon repairs
      • General surgery: Hernia repairs
      • Reconstructive surgery, insured: Breast reductions, mastopexies
      • Reconstructive surgery, uninsured: 360-degree body contouring, liposuction, breast augmentation
    • Reduced surgical costs: During the initial proof of concept phase in 2016, the average cost per case was based on three factors: human resources, disposables and anesthesia costs. Total costs for Tier 1 procedures were 56% lower in the Surgi-Centre than in the hospital OR. Costs for Tier 2 procedures were 30-34% lower.
    • Improved patient experience: Comparative patient surveys indicate that patient experience scores are noticeably higher for procedures conducted at the Surgi-Centre than at the hospital. ASC patients spend on average 82.5 minutes less in post-op recovery at the Surgi-Centre than they do in a hospital OR. Additionally, readmission rates for Surgi-Centre patients are quite low. Less than 1% of patients who receive a surgical procedure at the Surgi-Centre are operated on again within two weeks of their original surgery.
    82.5

    Average number of minutes saved in post-op recovery for ASC patients at the Surgi-Centre compared to hospital OR

    Footnotes

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