No matter how perioperative departments calculate this, if it’s less than 80%, there’s room to improve operating room utilization. Surgical leaders might be happy with their utilization as a metric, but there are always more problems to solve. These may include new surgeons not being able to get block time, surgical block owners resisting changes, nurses and anesthesiologists needing more predictable schedules, and management wanting more efficiency. Especially at a time when healthcare organizations struggle to attract and retain staff, addressing these issues is critical. Even if operating room utilization numbers look strong, therefore, there are always ways to make them stronger.
In my more than a decade as a perioperative business manager, I’ve seen dozens of approaches and projects to improve operating room utilization and efficiency. Efficiency improvement projects typically focus on reducing first case delays and turnover times. In our experience, first case delays and turnovers are in fact a very small piece of the pie when it comes to improving overall perioperative efficiencies. Every operating room is different and maximizing its efficiency requires a unique approach. However, there are three simple things to implement right now that will improve operating efficiency continuously.
1. Remind surgeons to request and release blocks in advance
One of the easiest steps to improve operating room utilization is to remind surgeons and their schedulers to release blocks they don’t plan on using. More often than not, abandoned surgical blocks (blocks that are not released that end up in RFT, for example) are not utilized efficiently. Proactively reallocating released blocks to needy surgeons increases block utilization. So if a surgeon does not have cases scheduled for the upcoming week, remind them to release the block and assign it to a surgeon that could use it, rather than letting the block go abandoned (and unutilized).
Similarly, when a block becomes available, send a notification to all surgeons looking for block time and allocate it on a first-come, first-served basis. Such just-in-time alerts enable block reallocation before blocks go abandoned, and that increases overall surgical and block utilization. By using this process Baptist Health Jacksonville achieved an 11% point increase in block utilization. Dignity Health’s Sequoia Hospital, meanwhile, increased block utilization by 10%, and also saw a two-fold increase in minutes released.
2. Increase transparency across the board
There are two issues with operating room metrics as they are commonly applied today.
First, not all metrics are actually meaningful. For example, it is not effective to simply tell a surgeon their utilization is 57% and they need to improve it. Surgeons are intrinsically motivated to use their time efficiently, and many times factors outside their control negatively affect their metrics or incentivize the wrong thing. For example, a surgeon who plans six hours for a valve replacement can sometimes finish in four hours and that negatively can affect their utilization on that block.
As unexpected results like this are common, asking surgeons to improve their utilization does not help. It is more productive to delve deep into their utilization patterns and provide more practical recommendations. For example, if a surgeon consistently does finish their cases three or four hours early, that’s an opportunity to recover some time from them and make it available to someone else. There also is an opportunity to schedule those cases more precisely with improved case length accuracy analyses. Additionally, if a surgeon is consistently releasing too many blocks, that’s worth having a discussion to see if those blocks can be reallocated proactively. Surgeons welcome such practical discussions much more than policing utilization.
Second, not everyone is aware of the high-level metrics. Even an organization’s CEO may have visibility into revenue targets but not into operating room utilization and how that impacts revenue. But when everyone is informed about the high-level performance targets, they do their part to meet them. Having a consistent set of top-level performance goals and metrics and keeping everyone informed goes a long way toward inspiring people to work toward improving them.
3. Build flexibility into operating room management
Every day, we are working with perioperative departments that are struggling to balance surgeons’ demand for operating time with severe staffing and resource constraints. These constraints naturally impact operating room utilization and surgeon satisfaction as rooms must be closed based on available staff or anesthesia coverage on a given day. Building greater flexibility into perioperative room management means making it easier to open and close rooms, communicate status to surgeons offices, and give offices visibility into available time.
As we have experienced post-COVID, many hospitals are now working through backlogs of elective surgical cases. Having an understanding of these backlogs and helping the surgeons’ offices better triage their backlogs enables both the operating room and the offices to better plan for future volume.
In addition, facilitating transparent and ongoing communication with clinic schedulers is also a key to increasing flexibility. Through effective triage messaging, including knowing which surgeons were available and credentialed to perform surgery at different locations, and what criteria each surgical location had for booking cases at a given time, clinic schedulers are not only able to be updated quickly on changing circumstances, but are able to respond to them immediately, and not wait on hold.
For more on a solution that promotes awareness, transparency, and communication among surgical teams, in order to improve operating room utilization, see the iQueue for Operating Rooms or visit the resource page for stories of hospitals’ success in this change.