Post on 17-Dec-2015
transcript
OR Dashboard Metrics
• Volume– Case Volume– Case Minutes– Case Minutes by Time of the Day
• Utilization– OR Utilization by Day of Week– Block Utilization
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OR Dashboard Metrics
• Operational Stats– Turnover Time– On Time Starts– Cancellations– Add Ons– Overtime Minutes
Case Volume
• Reflects total number of cases over time• Compares inpatient to outpatient volumes• Allows you to follow growth as well as seasonal
variation– The following sample hospital has a decrease
in volume in August which reflects a time when many surgeons take vacation
• Average number of cases per OR per year in best practice ORs – Inpatient 900 cases per OR/year– Outpatient 1400 cases per OR/year
Case Minutes
• Reflects total number of minutes of surgery per month.
• Also reflects growth as well as seasonal variation• Comparison between volume and minutes helps in
determining growth patterns– Increase in volume with a small increase in
minutes usually means a growth in smaller cases usually outpatient
– Small increase in volume with a larger increase in minutes usually means a growth in longer cases usually inpatient
Case Minutes by Hour of the Day• Allows you to look at what percentage of case minutes
are completed in each shift• Goals
– 90% of minutes completed between 7am-3pm– 95% of minutes completed by 5pm
• Following sample hospital graph shows a process improvement project that started in June at 84% completion by 3pm with increase of completion to 90% over 6 months. Processes addressed were
• Start time• TOT• Revision of block schedule• Staffing levels
OR Utilization by Day of the Week
• Reflects total OR utilization on each day of the week• The goal is to even out the utilization so there is little
variation between the days of the week• Goal in best practice ORs is 75%-80% total OR
utilization. This allows adequate “flex” in the system• The following sample hospital revised its block
schedule to allow better utilization of Thursdays and Fridays
Block Utilization
• Block utilization is calculated by surgeon/service• It is best to use adjusted utilization in order to not
penalize a surgeon for TOT– Adjusted Utilization= total block minutes
utilized +TOT/ total block minutes available • Goal is 75% block utilization in order to maintain block.
When decreasing blocks according to utilization you should decrease by days of the month not hours of the day– Example: A surgeon w/ 50% utilization of a
block on Monday would have the block reduced to either the 1,3,5 Monday of the month of the 2,4 Monday
OR Start Times• Defined as time patient enters the operating room
• Usually monitored at exact time and within 10 minutes
– Example: 0720 exact time while also monitoring the 10 minutes later at 0730
• Goal is 90% within 10 minutes
• Sample hospital on next slide reflects a PI project that improved start time from 65% to 85%. Issues addressed were
– Communication between team members
– Monitoring of start times
– Communication to surgeons the importance of on time starts by the OR committee
– Change in Preoperative Patient preparation
Average Turnover Time• Turnover time is calculated as patient out of the
room to next patient in the room• We usually follow same surgeon turnovers since
there is quite a bit of variability when turning over between 2 different surgeons or services
• Goals– Outpatient 10-20 minutes– Inpatient 30-40 minutes
• Sample hospital slide shows a PI project that begin in April. Issues addressed included– Staffing Levels– Communication between team members– Preoperative patient workup
Overtime Staffing Minutes• Reflects amount of overtime minutes paid to OR staff• Sample hospital PI project decreased overtime minutes
significantly over a 4 month period by addressing– On time starts– TOT– Staffing levels by time of the day– Block Scheduling
• Gaps in schedule• Overbooking.
– Example: A surgeon with an 8 hour block routinely runs 10 hours. The block should be adjusted to 10 hours and staffing levels changed to meet this need
Cancellations
• Usually monitor same day cancellations• Factors that impact cancellations
– Preoperative preparation including pre-anesthesia testing and patient education
• Sample hospital slide shows a PI project for preoperative preparation that included a pre-anesthesia testing clinic, that provided not only testing but patient education and financial counceling/insurance verification
• Goals – <1% for an outpatient setting– <10% for a major trauma center
Add Ons
• Reflects adequate open/urgent time– Open time is time available to anyone and can
be booked in advance. This accommodates the non-blocked surgeons
– Urgent time is time available starting 24 hours before. This accommodates many cases that need to be done urgently but are not emergent. Many general surgery and urgent ortho cases fit into this category
• Goal < 20%