Leveraging Perioperative Capacity to Optimize System Efficiency How simulation can enable holistic...

Leveraging Perioperative Capacity to Optimize System EfficiencyHow simulation can enable holistic capacity strategies

October 5, 2015

GE Healthcare PartnersRyan Treml – Consulting ManagerSteve Verdi – Senior Consultant

2GE Healthcare Confidential and Proprietary

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All illustrations or examples are provided for informational or reference purposes and/or as fictional examples only. Information contained herein is proprietary to GE. No part of this publication may be reproduced or used for any purpose without written permission of GE.

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General Electric Company, by and through its GE Healthcare division

Agenda

GE Healthcare Partners Overview

The Need for an Institutional Capacity Strategy

Systems Approach to Capacity Optimization using Simulation Modeling

Simulation Outputs and Insights

Putting Model Insights into Action


GEHC Partners Expertise

Change Leadership & Strategy ActivationCreate market leaders by helping activatestrategy and unlock potential

Care Delivery ManagementTransform flow of patients to help optimize utilization and decrease cost

Integrated Whole System CareCreate actionable strategies to drive growth, enhance market position and improve financial performanceStrategic Resource & Cost ManagementHelp clients improve operating margins via resource allocation and utilization optimization

Change le

adersh

ip

Advance

d a

naly

tics and d

ecisio

n

support

Know

ledge Tra

nsfe

r and su

stain

ed

resu

ltsGE HealthcarePartners


GE Healthcare PartnersGE Healthcare’s independent consultancy

US Clients International Clients

Clients determine our success.

Data trumps a good guess. Optimize the

system and the parts.

Agnostic.

Institutions and individuals must

change.

Heroic is great. Sustainable is

better.

Diverse global experience


Capacity Related Trends in AMCs

“There cannot be a crisis next week. My schedule is already full.”

- Henry Kissinger

4-8Hours of ED

Boarding

25+

OR Holds/week

55+

Incoming transfer

declines/month

7

90+% occupancy rates lead to operational challenges:


Re-Thinking Capacity Management

Local Solutions System Solutions

Bandage Root Cause

Educated GuessDecision-Support

Tools

Data Information

Early Success Sustainability

Force-FeedChange

Management

Fragmented Oversight

Governance Structure


System Impact of Variation

Decisions only delay

the individual

Only major events trigger delays

Minor events have large impact

Hospitals facing high occupancy require systems thinking to appropriately manage capacity


The Hospital as a System


The Hospital as a System


Why Simulation?• Creates visibility to ‘hidden’ factors for

consideration in next generation of operations management

• Produces a clear view of the interdependencies & adjacencies that challenge operations and patient satisfaction

• Allows for investigation of multiple solutions in a test environment – reduces the risk/difficulty of testing solutions in an active patient care environment

• Enables data driven and informed decisions to plan for today’s needs while also highlighting future constraints and opportunitiesSimulation is used to gain a systems view of potential changes,

providing non-intuitive insights to solve complex problems


Model Design & Build

PathwaysThousands of unique physical pathways based on historical

sequences

Patient TypesGroupings of patients with

similar pathways & statistical behavior

Arrival VolumeGrowth, seasonality, daily

and hourly variations

OR Length of Stay

Distribution in hours

Unit LOSDistribution in

days

ExitUnit D/C curves by hour applied on final day of

stay


Analysis Enabled by Simulation ModelingExamples of Commonly Tested Scenarios

Growth and Other Volume Change

Managing Variation

Bed Capacity and Routing

• Organic volume growth• Add/loss of surgeons• Change in case mix/type

• Capping ICU postings• Shifting block time• Opening buffer capacity

• Inpatient bed algorithm• Flexible Prep/PACU• Utilizing outpatient space• Demand-based discharge


Example Model InsightsReducing week-to-week ICU arrival variation

Variation in scheduled arrivals to ICUs results in census variation, creating weeks of high occupancy and other weeks of underutilization. Balancing the block schedule can reduce arrival variation and prevent weeks in which the ICU is full.

ICU Census - Baseline ICU Census – Reduced Arrival Variation

54% reduction in Hours at Full

Capacity

40% reduction in

census variation

38% reduction of wait time to

enter ICU


Example Model InsightsShifting Inpatient Discharges to Lead Demand

Misalignment of bed demand and bed capacity creates a midday census peak on inpatient units that prevents queued demand from finding beds. By freeing the right capacity at the right time, we can level census and reduce waiting for beds.

0 1 2 3 4 5 6 7 8 9 10111213141516171819202122230

1

2

3

4

5

6Actual Discharges vs Targets

Cum. Historic Exits

Hour of Day

Dis

charg

es

Discharge Targets: • 1 discharge by 10a• 1 more discharge by

2p• 1 more discharge by

5p• …

18% reduction in ED

Census

22% reduction in ED

boarding

30% reduction in OR

holds for ICU beds

9% reduction in ICU

utilization


Solution Prioritization Matrix

ScenarioB Reduce PACU LOSC Sharing CapacityD Reduce Empty Bed TimeE Reduced LOSF ED Process ImprovementG Extended Stay Recovery UnitH Add Monitored BedsI Elective ICU CappingJ Case sequencing within the dayK Shift OP Volume to Outpatient

LDedicated OP PACU in Surgery Unit

M Pool PACU CapacityN Pediatric OBS unitO Fully Staff PACUP Peds Routing by Age OnlyQ Fully Staff ICUs

High

Low High

Solutions tested in the simulation model are compared based on the overall impact on capacity and difficulty to implement. This prioritization funnel feeds the project timeline and sequencing of work.

2015 2016

2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10

Urgent Admission Transfer Process

IPOM (Interactions, Procedures and Op Mechs)

Wall of Analytics

Aligned Discharge

Perioperative Throughput

Project Timeline

Access Line, Admitting, Bed

Center Workflows

Patient Placement Practices

Solutions are grouped into project workstreams, then evaluated for proper sequencing to prioritize capacity improvements to allow flow

Command Center Go-Live

• Discharge by Protocol

• Additional Phase 2 capability

• RN staffing and documentation

• Mgmt of ICU patients in PACU

Project Timeline – Perioperative Workstream

Initial Focus AreasProjects were targeted to address immediate capacity needs and key processes

Perioperative Throughput

PACU Throughput

Outpatient Surgery Center

ICUCentralized Scheduling

Potential Future Focus Areas

Block Scheduling

Scheduling Policies

Utilization Governance

OR Process Efficiency

OSA / ESR patients

• Reduce exclusionary criteria

• Shift add’l OP cases to OPSC

• Review need for additional rooms

• Address sequencing of cases to reduce downstream bottlenecks

• Identify alternative capacity options to cover post-surgery ICU demand

• Create additional capacity for extended stay patients

• Address monitoring capacity

• Improve standardization of case scheduling / posting sheets• Improve

sequencing of cases / volume

Adding additional OR volume would exacerbate downstream problems, therefore Block Schedule, Governance, and OR processes were

sequenced in second phase


Command Center with Wall of Analytics

GE Healthcare Proprietary

Co-locate staff & concentrate information to:

• Improve access to the people and information necessary to make critical decisions at the moment they are needed• Provide real-time decision support tools that make data meaningful and actionable• Deliver detailed information that aides in identifying opportunities to improve hospital operations


Wall of Analytics – Under Construction

Takeaways

• Optimizing for the individual is no longer possible; impact of localized decisions need to be compared against system efficiency

• At high occupancies small changes have a large impact

• Managing variation is the hardest and most critical area of focus

• Cultural transformation is needed… modeling helps build the case for change

Questions?

Thank You!

Ryan Treml, Consulting Manager

[email protected]

(773) 518-0316

Steve Verdi, Senior Consultant

[email protected]

(262) 951-1595

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