Surgical Services

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Surgical Servicespresent stateand how did we
get here..SIP 5 report 3/1/05

• Renae Battie, Peter Buckley, Judy Canfield,
  Shelley Deatrick, Mark Schierenbeck, Helen
  Shawcroft

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And then we started to grow.

• 1978 Addition of SCOR OR 15-16
• 1985 addition of OR 8-14 (13 shelled)
• 1990s OR 13, 17 opened
• 2001 Addition of OR 20
• 2002 R2 ASC opened with 2 OP ORs
• 2003 Nov--Pavilion Surgery Center opened with 6
  ORs (5 shelled) (4 main ORs closed)
• 2004 (Feb) 2 Main ORs using 2 Pav rooms
• 2005 (April) Pavilion Short stay opens 7 new beds

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UWMC Ambulatory Surgery Center at Roosevelt

• 2 OR ASC
• Geographically separate from Hospital
• Ambulatory only
• Parking in the basement
• Narrow spectrum - Eyes/Hands/ENT/Plastics
• Closed Surgical Staff
• Unique/designated staff
• Unique leadership initially
• Equipment - site specific
• Instruments shared
• Supplies shared
• Sterilization off site

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R2 ASC

• Retro fitted into existing Medical Office
  building
• Planning start 10/00
• Construction start 06/01 15 MONTHS
• Open for business 01/02

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JOINT CLINICAL PLANNINGTASK FORCE - 1998

• Charge Identify and evaluate program options
  for the 160,000 gsf pavilion. To Consider
  external factors, projected clinical growth
  service requirements of the UWPN clinics, current
  effort to examine near-term options for decanting
  ambulatory surgery volumes, impact of reductions
  in GME support.
• Data Sources Analyzed
• Current volumes
• Forecast future volumes
• External environmental scan
• Experiences of other academic medical centers
• Internal survey of potential need

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JOINT CLINICAL PLANNINGTASK FORCE (Contd)

• Recommendation on core services to be included in
  building
• - Ambulatory Surgery
• - Pre-admission testing
• - Minor procedures
• - AM admit
• - Observation unit
• List of other candidate programs

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JOINT CLINICAL PLANNING TASK FORCE (Contd)

• Recommendation on core services to be included in
  building
• Ambulatory Surgery, Pre-admission testing, Minor
  procedures, AM admit, Observation unit
• List of other candidate programs
• Project Goals
• Provide capacity to meet increasing demand for
  services provided in an ambulatory setting
• Provide significant additional OR capacity
• Provide a single site for all surgery check-in
• Create an ideal patient experience
• Provide an ambulatory teaching setting

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PROGRAMMING COMMITTEE - 1999

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• - Robert Muilenburg, co-chair - Mika Sinanan,
  MD, co-chair
• - Peter Buckley, MD - Rick
  Matsen, MD
• - Judith Canfield - Al Moss,
  MD
• - Alex Clowes, MD - John Olerud,
  MD
• - Mickey Eisenberg, MD - Jim
  Ritchie, MD
• - Jim Fine, MD - Bruce
  Rothwell, DDS
• - Ben Greer, MD - Kathleen Sellick
• - Paul Ishizuka - Dan Silbergeld, MD
• - Mike Kimmey, MD - Preston
  Simmons
• - Paul Lange, MD - Ernie Weymuller, MD
• - Eric Larson, MD - Steve Wilson, MD

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PROGRAMMING COMMITTEE (Contd)

• Reviewed Joint Clinical Planning Task Force work
• Solicited future plans and projections from
  clinical services
• Reviewed demand forecasts for surgery (inpatient
  and outpatient)
• Agreed upon building theme and occupants
• Agreed upon sizing of OR suite, based on demand
  forecast and room utilization model

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PROGRAMMING COMMITTEE

• Vision
• Create a facility to compete with the best in the
  region
• Create the ideal patient experience
• Create the ideal faculty and staff environment
• Be the principal site for ambulatory surgery
• Design for operational efficiency and flexibility
  in patient care
• Create new academic opportunities for
  programmatic development, education and research

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PROJECT MANAGEMENT COMMITTEE

• Oversee final design and construction phases of
  project
• Advise on budget/ project scope issues
• Communicate about project progress to colleagues
• - Eric Larson/Ed Walker, MD Mika Sinanan, MD,
  co-chairs
• - Peter Buckley, MD - Paul Ishizuka
• - Judith Canfield - Mike Kimmey, MD
• - Patch Dellinger, MD - Tom Trumble, MD
• - Bill Ellis, MD - Barbara Zuelzke

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Functional Unit (OR)Forecast Methodology
Workload Forecast X Proc Length
Clean-up / Operating Hours/Year / Goal
Utilization Rate X Scheduled Procedures Operatin
g Room Forecast
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Washington State Population ForecastPercentage
Change Per 5 Years
Annually 1
Annually 1.5
Annually 1.5
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King and S. Snohomish Counties Pop Projection
2000-2020 Growth
Change 2004-2015 11, just over 1 per year
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Surgery Workload Forecast
Currently for fy05
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Surgery Caseload Forecast
Currently at 14653 for fy05
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Like Institution Benchmarks
UW Stanford UCLA USC UCSF
Cases 11,500 23,000 21,000 17,000 10,000
ORs 19 33 41 32 450
Cases/ OR 600 700 500 530 450
OP 47 59 43 24 21
IP Mins/ Case 235 196 255 203 247
OP Mins/ Case 113 103 78 114 109
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WORKLOAD SCENARIO DEVELOPMENT
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SUPPORT SPACE VERIFICATION
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Pavilion Services and Departments

• Third Floor Pre-Surgery Clinic Imaging Surgery
  Clinic GI/Endoscopy
• Second Floor 11 Operating Rooms AM Admission OP
  Surgery Check-in Surgical Short Stay Pre Post
  Procedure Holding and Observation
• First Floor Urology Clinic/Prostate Center Food
  Service/Conference Center Building Support
  Services

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Ready go---

• Built from the ground up
• Planning start 05/99
• Construction start 10/01 54 MONTHS
• Open for business 11/03

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UWMC Surgery Pavilion

• 11 OR ASC using 6 ORs
• One floor ORs, two floors Clinic /Endoscopy
• Connect to Hospital via skybridge
• Ambulatory (70), LS (15), IP (15)
• Sole site for DOS admits

• Parking in the basement
• Broad spectrum practice
• Unique/designated staff
• Unique leadership

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Other Goals

• Increase sq footage of ORs
• increase of ORs
• using latest in technology
• infrastructure for digital age
• support next ten years of development of
  technology and growth

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What other changes with the new site?

• All preop patients in one site
• Standardization of rooms, PLs, processes
• schedule boards compliant with HIPAA
• automation of pharmacy and implants
• pleasant environment for patients, families,
  staff
• create a new culture of efficiency

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AMBULATORY SURGERY
HOME
Patient Flow
Patients pulled check by system controller
OR  
    Pre Post Op
  Check-In    

Pre-Op Procedures
Straight Back
MAIN OR
Admit to Hospital  
Main Pre-Op  
  OR    
  PACU
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Whats the vision?

OR
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Standards for Pt flow

• Attentiveness to patient start times and plan
• Parallel actions vs consecutive actions (next pt
  ready by end of current case)
• Case prep done day before minimal schedule
  changes
• Pt preparation complete on arrival
• Comfort/flexibility of shared tasks by team
• Adjusting amount of teaching time to goal of on
  time starts
• Develop standardized, lean setup cases

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Tracking Metrics

• On time surgical (starts within 15 min)
• Room turnover (20 min or less)
• surgeries completed as scheduled (95)
• Case cart accuracy (95 of all items present)
• Standardization of care (50 reduction in case
  variation among top PLs)
• Patient readiness (all ready at arrival)
• Patient wait time (less than 30 minutes wait)

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Stryker Integrated OR Information System-
EndosuiteSony Video Archiving System
Pavilion ORFront Desk
Conferenceand teleconference
Sony video archive
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UWMC OR Forecast
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R2 ASC opens Jan
Pav SC opens Nov.
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Pav SC opens Nov.
R2 ASC opens Jan
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Short stay opens
Annex opens
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4NE Midnight Census Trends
August 2004
September 2004
October 2004
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4NE Midnight Census Trends
November 2004
December 2004
January 2005
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4NE Midnight Census Trends
February 2005
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Annualized
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Annualized
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Annualized
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Annualized
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Visionor Hallucination?

• Exceptional leaders cultivate the Merlin-like
  habit of acting in the present moment as
  ambassadors of a radically different future, in
  order to imbue their organizations with a
  break-through vision of what it is possible to
  achieve. Charles E. Smith, management
  consultant