Operating Rooms (ORs) are a hospital’s most costly operational area. When run efficiently the OR can be a source of solid revenue, but when run inefficiently, it causes operational and fiscal heartburn. Much focus is centered on turnaround times, which is identified a primary source of problems. Operating room turnaround time is the time between a patient “Wheels Out” (WO) and when the subsequent patient “Wheels In” (WI), and is important to a surgery center’s performance but difficult to manage well. Minimizing this time is critical but delays often occur which cause fewer surgeries to be completed resulting in less revenue.
Process improvement
Hospitals and surgery centers have long used process improvement methods such as the so-called Lean Method to eliminate waste in patient flow. Numerous studies have found ways to assure only value-added steps occur. Many other studies have found significant waste in terms of delays and unnecessary steps. Thus, the “traffic cop” for surgery must make sure patients and staff must be in the right place at the right time. Since so many people involved, it is inevitable that waiting for one person, patient or equipment often occurs.
One way to combat these delays is to have real time information on who is where and what tasks are ready to start or are complete. If there are multiple operation rooms the status reporting is very challenging. Hospitals have tried various techniques to keep track of what is happening such as video monitors and beepers as well as paging, status boards and telephone calls. However, now new options now exist in terms of smart phones and electronic tracking devices.
New technology has been successful in reducing the overall turnaround inefficiencies. The technology employs a powerful combination of electronic tags using RFID devices such as are used to track merchandise in department stores to track the real time location of patients, assets and staff and automated alerts and statuses via specially programmed smart phones - this provides hospital management with the information they need for advanced planning and in-the-moment course corrections throughout the day.
RFID is the most popular hardware used for electronic patient tracking. This technology is also referred to as RTLS (Real-time Location System) which encompasses designs using various electronic technologies combined with software to analyze, store and transmit location and time information. Like most electronics, their cost has been decreasing to $4 or less for single-use active RFID tags as their capabilities have increased. Patient tracking can be done by staff entering patient information and location data into a computer system, but RFID provides the advantage of automatically precisely capturing key events in the patient flow without interrupting patients or staff.
Having both RTLS on the patient and the smart phones for staff locating and timestamps adds synergy to the system. Such comprehensive information has resulted in very prompt turnaround time, particularly regarding housekeeping (EVS) workflows.
The RTLS alerts EVS to an upcoming room cleaning, and once initiated, tracks the progress of EVS and other staff so that the room can be turned over and the next patient can be moved into the OR as soon as possible.
A constraint on room turnover is getting the EVS staff to the right OR as soon as it is available or cleared for cleaning. This means alerting EVS that a room is soon to be available for cleaning, so they should gather necessary supplies and head to the room as close to WO as possible. Sometimes EVS can begin even before wheels out occurs.
Also, being able to capture and monitor the results of patient and staff timing is very helpful in managing surgery flow. Usually, the timing of most workflow events is not captured. However, with RTLS we can gain key insight into EVS and other patterns. More importantly, it provides the hospital with hard metrics that they can track and benchmark going forward in performance improvements.
In one recent implementation of an RTLS system by Tagnos, Inc. at a large hospital surgery department EVS arrives, on average, about the time the patient wheels out. The arrival time averages one minute before the patient wheeled out and 65% of the time they arrive on or before wheels out time.
The economic benefit can be determined based on the time saved. Surgery is a particularly expensive activity and can be looked at on a per minute basis. The resulting savings can be substantial in terms of making additional surgeries possible and reducing overtime due to late surgery starts.
Potential future impact
Having the ability to know the location of where all people and equipment are located creates opportunity for many future improvements in various room turnaround steps – including Anesthesia and BioMed workflows related to room turnaround, to name a few. Having an accurate and complete record of the time and location of staff, equipment and patients makes it possible to significantly improve scheduling and planning surgeries.
David Belson, PhD
David Belson, Ph.D. has helped dozens of hospitals and clinics improve productivity by applying his background of over 30 years as a professor in Industrial Engineering. He teaches improving health care operations at the University of Southern California’s Viterbi School of Engineering. He has conducted research projects funded by the California HealthCare Foundation and the California Hospital Association. Recent work includes Lean training for all California Critical Access hospitals and for the California Quality Consortium; research at San Francisco General Hospital; Process Improvement at hospitals such as St Francis Hospital in Lynwood; Los Angeles County General Hospital; Children’s Hospital of Los Angeles; and others. Dr. Belson is currently working on Quality Improvement grants from the US Veteran’s Administration and for several California Hospitals; recently helped found the Society of Healthcare Improvement Professionals and is the editor for the society’s Journal. His work has been published in “Gastrointestinal Endoscopy” and “Gastroenterology Research and Practice” and he’s prepared a handbook for Quality Improvement for the VA. He has a BS Degree in Engineering from the University of Washington, an MS from UCLA and a PhD from USC.
