Improving the operating room efficiency using a lean approach

Operating room efficiencies are vital to patient satisfaction, staff satisfaction and financial success of a hospital as they are highly resource intensive. Any inefficiency or delay in the operating room can lead to a decrease in the revenue and surgeon frustration. Leading causes of operating room inefficiency are delays with the First Case Starts (FCS) and unknown Turnaround Time (TAT). FCS and the TAT were the two metrics used in this project to monitor the efficiency of the operating room. The main purpose of this Operating Room (OR) process improvement project was to improve the OR efficiency by improving the patient flow, increasing the OR utilization, improving the quality of care and improving the staff and patient satisfaction using a lean approach. The various improvement strategies implemented in the project would provide powerful capabilities for strategic management of resources, tactical scheduling and standardized evaluation of the key performance indicators which will improve the patient satisfaction by reducing the patient wait times and increase the hospital revenue. The main goal focused on reducing the TAT average for each surgical service and increasing compliance with the FCS. Turnaround time is defined as the duration between the previous case “out of room” time and the following case “in room” time. The time required for cleaning the room, transferring the patient to the OR and prepping the surgical instruments is included in the TAT. The baseline for cleaning the room was 20 minutes but this varied depending on the type of surgery. The average turnaround time for the year 2018 was 34.74. Our goal is to reduce the turnaround time and reach a target of 30 minutes. FCS is considered the first procedure of the day starting between 6:15-9:30 am and is recorded as the wheels in time less than 6 minute post scheduled start time. Thus any procedure starting 6 minutes post scheduled time is considered as a delay in the first case. Methods included evaluation of the key performance indicators such as the FCS, TAT, block utilization and the procedure time. The Key performance indicators were measured before and after the implementation of the strategies to measure the improvements. The OR manager maintained a log of the FCS delays that were followed by a discussion at the OR leadership huddle. The TAT delay reasons were collected both manually, and through the nurses who recorded information in the EPIC electronic medical record software. The results of the data were analyzed daily and displayed in the OR. Results showed that surgeons were the top reasons for the FCS delays taking place in the OR. Thus, surgeons with the longest delay in the FCS were reported, and letters were sent to them which mentioned they might lose their block time if the stats didn’t improve. A physician survey showed that 90% of physicians believed that they were not receiving a sufficient amount of data regarding their operating room metrics. Thus, a physician dashboard system was developed which displayed the physician’s operating room metrics graphically. Public Health Statement: The main purpose of developing the physician dashboard system was to improve the data access to the physicians to improve their productivity in the OR. Displaying the results to the leadership and the OR staff facilitated this project and improved the efficiency of the OR considerably