SIP 5 Measuring

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SIP 5Measuring Managing OR Capacity/Utilization

• Peter Buckley, MD
• Lisa Brandenburg, COO
• July 5, 2005

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UWMC Surgical Block
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Surgical Block

• Staffed minutes with RN/CST/CRNA/Anesthesia.
• Allocated to Surgical Departments
• Department accountable for management of their
  block
• Surgeon accountable to accurately schedule
  elective cases into block time/ case load to be
  site appropriate/stay within block, not run over.
• Block is time specific, not OR specific.
• Subject to some rules- release, closure, etc

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Block Perspectives

• Full Block
• Open Block
• Surgeon Specific Block
• Partial Block

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Main Operating Room Block
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Pavilion Block
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Historical Block Distribution

• Block apportioned based on historical utilization
  of OR (1996)
• Block distributed on Surgical Department basis,
  not surgeon (1996)
• Surgical Departments allocate times/block to
  individual Surgeons
• Block time is specific, not OR specific (1999)
• Block is Surgical Department specific, not
  surgeon specific

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Block Utilization Formula

• Total Dept. Block minutes used national TO
• Total Dept. Block Allocated- release time
• Block releasedept. relinquish time 5 days
  before surgical day.

Albany Medical Center 1 week full credit
Wake Forest University 30 days full credit
Abott NW Hospital 2 weeks full credit
Parkland Hospital Not answered
UHC Best Performance
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Surgical Pavilion with Block Release, May
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Surgical Pavilion with No Block Release, May
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Reallocation of Block

• 2002 3 month rolling avg. including release gt70
• 1999 3 month rolling avg. including release gt70
• block release
• Attempted every 3 months
• UHC comparisons

Block Utilization Phone Survey of UHC Hospitals Block Utilization Phone Survey of UHC Hospitals Block Utilization Phone Survey of UHC Hospitals
Target Actual
Albany Medical Center 75 75
Wake Forest University 80 70-79
Abott NW Hospital Not Answered
Literature Review
Johns Hopkins 85
Northwestern 80-85
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Established Surgeon
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New Surgeon Start up
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New Surgeon Start-up
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  CHANGES IN SURGICAL UTILIZATION
Total () IP() OP()
1994 9833 5557 (57) 4276 (43)
2004 14030 6846 (49) 7184 (51)
Mean annual change 2.7 2 6
2005 (proj.) 14628 6984 (47.5) 7644 (52.5)
Annual Change 4.2 2 7.7
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Impact of Block Release on OR Utilization

• w/release release w/o
  release
• Main 72 9.6 67.7
• Pavilion 72.6 11.6 64.5
• R2 67.7 15.4 57.2

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Why Block Release

• To account for expected and predictable surgeon
  absences
• 4 weeks vacation
• 4 weeks meetings
• Surgeon usable year 52-844 weeks (release
  8/5215.4)
• No current agreement and operational limitation
  of block release

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What To Do About Block Release

• Is Block release used?
• Elective scheduling before block closure
• TBA/Red-Urgent/Emergent cases
• Change block release rules
• Predictable absences known well in advance eg.
  8-12 weeks
• full credit for advance release-?10 weeks out
• Partial credit ?6 weeks out
• Released block booked in entirety
• Study extent to which released block is used.
• Close down/do not staff unused proportion 4-6
  weeks out

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Other Ways to Measure Utilization
Billed Minutes/Staffed Minutes Raw Surgical Time Utilization Cut To Closed Minutes/Staffed Minutes
Main 71 52
Pavilion 53 36
Roosevelt 55 37
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UHC Conclusions to Maximize Room Utilization

• Match room coverage to demand, particularly on
  evenings
• Empower clinical services to manage their
  schedules
• Do not routinely hold rooms specifically to
  handle emergency cases
• Implement approaches to timely case starts that
  focus on timely collection of pre-op information
  and patient logistics
• Engineer an efficient turn-around process
• Implement daily performance management and
  reporting

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Health Care Advisory Board Conclusions to
Maximize OR Efficiency

• Improve turn-around time
• Ensure on-time starts
• Rationalizing Pre-operative Testing
• Optimize Block scheduling
• Achieve same number of hours of elective surgery
  daily

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Dollar Value to UWMC of Changes in Utilization
(in Contribution Margin)

• 5 Increase in Utilization at all Sites 3M
• 5 Decrease in Turnover Time 415K
• 20 Decrease in Turnover Time 1.7M

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Discussion Questions

• What are we trying to optimize for?
• What best practices should we adopt?
• How do we look at surgeon efficiency?