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
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
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
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
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?
ICAO Travel Document. Digital signing via contact interface with digital certificate (EU Qualified) ... User enters Application Portal. Hub. Attribute Manager. Identity Selector. User Centric Attributes - 2. Request to IDSP for credential with type of attributes.
Steve and Sue have been married for 35 years. Steve never worked and does not qualify for Social Security. Betty's benefits is $1800. At FRA, Steve's spousal benefit would be $900. Steve could begin receiving benefits at age 62, but...
Tree Grading Why Tree Grading? Provide a consistent estimate of tree quality Provide a consistent estimate of stand value Provide a more realistic estimate of stumpage value based on grades and lumber prices Provide a linkage between the standing tree...
The Loanable Funds Market Loanable Funds Market The market where savers and borrowers exchange funds (QLF) at the real rate of interest (r%). The demand for loanable funds, or borrowing comes from households, firms, government and the foreign sector. The...
FACILITY LOCATION LG4 Rising numbers of Internet businesses means brick-and-mortar retailers must find great locations. 9-* * * Potential of low-cost labor is very attractive to companies hoping to remain competitive. However, shuttering operations and moving can often cause severe...
Attention/Habituation. Attention studied using habituation and dishabituation. Habituation - gradual decrease in attention. Neonates - several minutes before dishabituation. 4 to 5 months - only several seconds. Infants become better at perceiving and processing stimuli. End of first year joint...
Groundwater is subsurface water that fully saturates pore spaces of bedrock. The rate of movement of groundwater is gravity driven, varying between 0.6 inches per day (in sandstones) to several inches per year (in granites) The source of groundwater is...
Ready to download the document? Go ahead and hit continue!