UWMC Surgical Block - University of Washington

UWMC Surgical Block - University of Washington

SIP 5 Measuring & Managing OR Capacity/Utilization Peter Buckley, MD Lisa Brandenburg, COO July 5, 2005 UWMC Surgical Block 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 Block Perspectives Full Block

Open Block Surgeon Specific Block Partial Block Main Operating Room Block UWMC - Surgical Services Main - Block Operating Schedule Effective July 8, 2005 MONDAY Time 15:30 Block Rooms 13 Room 1 7:45 Gyn 2 7:45 Oto 13:30 Gyn 3 7:45 Urol 4 5 7:45 Gen

Surg 6 7 7:45 Oto 8 7:45 Ortho 9 7:45 Ortho 13 13 10 7:45 Surg "C" 11 7:45 Surg "C" Cardia 12 7:45 Surg "C" Thor 13 14 7:45 7:45 TX Neuro \ SurgC Thor

20 7:45 Gen Surg BYRD 17:30 13 7 19:30 7 4 21:30 4 3 23:30 3 1 Note U/E Indicates site available for urgent/ emergent cases : U/E : : : U/E : : : U/E : :

: U/E : : : U/E : : : U/E : : : : : 7:00 Pavilion Block UWMC - Surgical Services Pavilion - Block Operating Schedule Effective July 8, 2005 MONDAY Time Block Rooms 6 + 2 Annex 285 Minutes Room 71 7:30 Oral 72 7:30 Urol 73 7:45

Oto 74 7:30 Close 75 7:30 Close 76 7:30 Urol 77 7:30 Ortho 78 7:30 Neuro 79 7:30 Neuro 80 7:30 Ophth Robot 12:15 17:00 19:00 6 + 2 Annex 6 + 2 Annex 6 + 2 Annex

1 2 Annex 285 Minutes Gen Surg 81 7:30 Close 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 Block Utilization Formula Total Dept. Block minutes used +national TO Total Dept. Block Allocated- release time** ** Block release=dept. 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 Surgical Pavilion with Block Release, May UWMC Surgical Services Utilization Summary By Service - Pavilion (Rooms 71 - 81, non-Annex) March 2005 thru May 2005 (3 Months) Min w/ 20 100.0 % 90.0 o f 80.0 70.0 77.2 77.1 77.9 76.4 71.6 60.0 U t i

l i z a t i o n 77.3 71.6 66.3 50.0 40.0 30.0 20.0 10.0 0.0 Oto Utilization % Total Block Time Release Time % of Blk Released Blk Min Used Non Blk Min Used Total Min Used 1,3 % of NBM Gyn Neuro Ophthal Oral Ortho Urology OTO

GYN NEURO OPHTH ORAL ORTHO UROL GenSurg SurgT Total 77.2 6,840 570 7.7% 5,282 1,474 6,756 21.8 77.1 12,540 570 4.3% 9,671 1,388 11,059 12.6 66.3 18,210 2,100 10.3% 12,075 512 12,587 4.1

77.3 15,075 2,100 12.2% 11,656 3,081 14,737 20.9 77.9 14,520 2,790 16.1% 11,304 3,350 14,654 22.9 71.6 51,450 1,140 2.2% 36,827 3,150 39,977 7.9 71.6 41,805 3,090 6.9% 29,926 1,189 31,115 3.8 76.4 32,430 7,905 19.6% 24,772 2,132 26,904 7.9

17.1 2,040 1,530 42.9% 348 98 446 22.0 72.6 227,340 29,700 11.6% 165,016 18,448 183,464 10.1 GenSurg Surgical Pavilion with No Block Release, May UWMC Surgical Services Utilization Summary By Service - Pavilion (Rooms 71 - 81, non-Annex) March 2005 thru May 2005 (3 Months) Min w/ 20 100.0 % 90.0 o f 80.0 70.0 60.0 U t i l i z a

t i o n 71.5 73.9 67.9 69.5 66.6 66.4 60.7 60.9 50.0 40.0 30.0 20.0 10.0 0.0 Oto Utilization % Total Block Time Blk Min Used Non Blk Min Used Total Min Used 1,3 % of NBM Gyn Neuro Ophthal Oral Ortho

Urology OTO GYN NEURO OPHTH ORAL ORTHO UROL GenSurg Total 71.5 7,410 5,297 1,474 6,771 21.8 73.9 13,110 9,686 1,388 11,074 12.5 60.9 20,310 12,371 512 12,883 4.0 67.9 17,175 11,656 3,081

14,737 20.9 66.4 17,310 11,486 2,489 13,975 17.8 69.5 52,590 36,573 2,182 38,755 5.6 66.6 44,895 29,895 943 30,838 3.1 60.7 40,335 24,482 1,988 26,470 7.5 64.5 257,040 165,739 16,111 180,784 8.9 GenSurg Reallocation of Block 2002 3 month rolling avg. including release >70%

1999 3 month rolling avg. including release >70% % block release Attempted every 3 months UHC comparisons 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* Northwestern 85% 80-85% Established Surgeon Professor Surgery Profile 800 700 600 500

400 300 200 100 0 1994 1995 1996 1997 1998 1999 Year 2000 2001 2002 New Surgeon Start up Assistant Professor Surgery Profile 350 300 Porter 250 Kadel Mulligan 200 Flum 150 Mann Oelschlager 100

Maronian 50 0 1996 1997 1998 1999 2000 Year 2001 2002 2003 New Surgeon Start-up New Surgeon- Rise in Surgical Case Load Percentage of cases (Year 3 & 4 average cases as baseline) Best: 132% Avg: 97% 140 130 120 110 100 90 80 70 60 50 40 30 20 10

0 Best: 92% Avg: 61% Best: 118% Avg: 74% Best: 103% Avg: 82% 4 5 Best: 91% Avg: 66% Best: 72% Avg: 44% 0 1 2 3 Quarters 6 7 CHANGES IN SURGICAL UTILIZATION Total (%) IP(%) OP(%) 1994 9833

5557 (57%) 4276 (43%) 2004 14030 6846 (49%) 7184 (51%) 2.7% 2% 6% 14628 6984 (47.5%) 7644 (52.5%) 4.2% 2% 7.7% Mean annual change 2005 (proj.) Annual Change 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% Why Block Release To account for expected and predictable surgeon absences 4 weeks vacation 4 weeks meetings Surgeon usable year 52-8=44 weeks (release 8/52=15.4%) No current agreement and operational limitation of block release 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 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% 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 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 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 Discussion Questions What are we trying to optimize for? What best practices should we adopt? How do we look at surgeon efficiency?

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