ISOC - Operating Room Task ForceEfficiency Comparison in OR

April 5, 2013, Hamburg

Ines Gurnhofer, Head of OR DepartmentMatthias Spielmann, MHA, CEO

Agenda

Short presentation of the project and the timeline

Feedback and problems with the evaluation / data quality

Comparison of the various resources with distinction in various orthopedic centers

Evaluation results

Common problems

Take Home Messages

ISOC Operating Room Task Force April 5, 2013 Hamburg2 │ 20.04.23

CV

Ines Gurnhofer

OR Management – Head of OR Departement Schulthess Clinic Zürich 2003-

Head of OR Departement Orthopaedic Hospital Speising Vienna 1996-2002

ICU Clinical Hospital Zagreb 1989-1995

University of Applied Sciences and Arts Luzern

MAS Management in social and health services 2005-2008

Vinzentinum Health Academy Vienna 1998-2008

Medical School Baden n. Vienna 1996-1997

Medical School Zagreb 1985-1989

OR- Management International Congresses: Vienna, Salzburg, Köln, Berlin, Zürich, Düsseldorf

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Task Force Operating Room – Efficiency Comparison

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OR management focuses on maximizing operational efficiency at the facility, i.e. to maximize the number of surgical cases that can be done on a given day while minimizing the required resources and related costs.

Operating room efficiency is a measure of how well time and resources are used for the intended purposes.

We have therefore opted to conduct an efficiency comparison using the operating process as a basis with three phases within the process:

Pre-operative process (induction phase) Delays and other problems

Intra-operative process (operating phase) Staff structure

Post-operative process (recovery phase) Nothing spezial

Task Force OR Project Timeline

April 2012 Kick-off Meeting with M. Spielmann, MHA, CEO, Project Leader

Mai 2012 Creating a questionnaire for our project

June 2012 Sending a questionnaire to ISOC- Clinics

July 2012 Deadline for answers

November 2012 – March 2013 Analysis - working on project results

Today ISOC- Meeting in Hamburg presentation

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Feedback and Problems with the Evaluation-Data Quality

– Failure to meet the deadlines

– Last questionnaires received in Nov. 2013

– From additional questionaires that we sent out in February 2013, only 60% return rate

– Various questions could not be answered because in some institutions various data points are not available

“Errors using inadequate data are much less than those using no data at all...”

Charles Babbage

1791-1871

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Number of Operating Rooms (per Institution)

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Number of Minutes allocated for Operations per Year

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Total Number of Orthopaedic Operations 2011 - 109`864

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Adjusted Utilisation

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Adjusted utilisation uses the total hours of elective cases performed within OR block time,including «credit» for the turnover times necessary to set up and clean up

Start- time Delay in Minutes

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Start – time Delay for Elective Cases per OR per Year

ISOC per day 168 min

ISOC per week 840 min ( 5 working days)

ISOC per year 42000 min ( based on operating 50 weeks per year )

McKinsey&Company

42000 min x 16€

672`000.00 € / 873`808 USD or «700 Operations» - 60 min HIP Prostheses

Delays in the operating room have a negative effect on its efficiency and the working environment

Delays can be attributed to human errors and system deficiencies and the surgical operating room is rife with both!

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Most Common Causes for Delays – Hospital Comments

Patient arrival at day of surgery

Transfer of the patient from ward to OR

Surgeon and anaesthesia late

Surgeons allocating too many procedures to a «300» min session

List order changes

Surgion defined wrong duration of surgery

Not enough induction area (parallel preparations of patients)

Long in- between cases changing time

Absence of anaesthetic preparation room

Preparation room for OR nurse – old building

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Delays in OR

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Lession to learn

Continuous documentation of all delays in OR

Detailed analysis of delays and classification by cause

Analysis of all operational processes

Process- knowledge check and training sessions if necessary

Intraoperative time management of surgeons needs to be improved

Permanent sensitization about “time loss” in OR and intraoperative inefficient time management

Decision-making competence: OR- Management Committee

OR- Statute accepted and signed by all Chief- Surgeons

CEO and hospital management must be involved to get higher decision competence

Trying to solve problems with infrastructure (sometimes impossible if hospitals are old)

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OR Statute

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Pre-operative Process (Induction Phase)

Preparing the patient for the operation

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Recommendations – Induction Phase

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A holding area for the preparation of the patient is very importantProcesses run faster with enough staff for patient positioning and parallel working

This affects preoperative delays and reduces themDelays in the start can be made up only with difficulties

Where the Induction takes placeCentral

induction areaInduction

areaOR

Campbell Clinic USA

Clinica Alemana Chile

Helios Endo Klinik Germany

Hospital for Special Surgery USA

Instituto National de Rehabilitaciòn Mexico

IRCCS Istituto Ortopedico Galeazzi Italy

Istituto Ortopedico Rizzoli Italy

Mater Hospital Australia

Royal National Orthopaedic Hospital UK

Schulthess Klinik Switzerland

Sint Maartens Kliniek Netherlands

Skàne University Hospital Sweden

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Situation with Anaesthetic Preparations

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Patient Positioning

Induction area OR

Campbell Clinic USA

Clinica Alemana Chile

Helios Endo Klinik Germany

Hospital for Special Surgery USA

Instituto National de Rehabilitaciòn Mexico

IRCCS Istituto Ortopedico Galeazzi Italy

Istituto Ortopedico Rizzoli Italy

Mater Hospital Australia

Royal National Orthopaedic Hospital UK

Schulthess Klinik Switzerland

Sint Maartens Kliniek Netherlands Spinal Local

Skàne University Hospital Sweden

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Staff Structure per Operation / CaseRN qualified staff Surgeons ,

AssistantsAnaesthesiology

Campbell Clinic USA 1 RN / 1 Surg. Ass. 1-3 1Anaesthesist / 1CRNA

Clinica Alemana Chile 1 RN / 1 Cert. Surg. Ass. 1-3 1Anaesthesist / 1Nurse

Helios Endo Klinik Germany 2 RN or OTA 1-3 1Anaesthesist / 1A. Nurse

Hospital for Special Surgery USA 1 RN / + Surg. Tec. 1-3 1Anaesthesist 1-2 OR /1Nurse Anaesthesist

Instituto National de Rehabilitaciòn Mexico

2 RN 1-4 1Anaesthesist

IRCCS Istituto Ortopedico Galeazzi Italy

1 RN / 1 Surg. Ass. 2 1Anesthesist 1-2 OR /1 Nurse Anesthesist

Istituto Ortopedico Rizzoli Italy 1RN/1 Surg. Ass./ 1 Cast. Nurse

3-4 1 Anaesthesist1 Nurse Anaesthesist

Mater Hospital Australia 1-2 RN 2 1 Anaesthesist

Royal National Orthopaedic Hospital UK

3 1-3 1 Consultant Anaesthesist

Schulthess Klinik Switzerland 2 RN or TOA 1-3 1 Anaesthesist 1 Nurse Aanesthesist

Sint Maartens Kliniek Netherlands 2 Surg. Tec. 1-2 1 Anaesthesist 1-2 OR1 Nurse Anaesthesist

Skàne University Hospital Sweden 1-2 RN 1-3 1 Anaesthesist 1-2 OR1 Nurse Anaesthesist

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Lession to learn

– Induction and patient positioning in OR reduce the efficient utilization of the operating room

– Patient positioning for orthopedic surgery is often complex, takes a long time and therefore may block valuable surgical capacities

– OR capacities must be maximized for surgical activities

– All supporting and accompanying processes need to be relocated away from limited OR space

– Otherwise any anesthetic complications may affect OR capacities

– Various int. OR projects and publications have shown that induction in the OR adversely affects the overall OR utilization

– OR Managers and Architects patronize for the future holding and central induction area

“only the flying aircrafts make money”

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Follow-up Project

Definition of parameters and time points for assessments

Monitoring and critical evaluation of all delays in OR

Analyze subspecialty-/ surgeon-specific allocation of OR capacity

Implement improvements based on previous assessments of OR efficacy

Then reevalute OR efficacy following these implementations

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Thanks for the attention!

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