The primary constraint to the timely delivery of patient care is access to often-scarce resources, and fewer resources are more scarce than operating room (OR) time. Available OR time is often in short supply, and the consistently unpredictable demand for it compounds the challenge of allocating and utilizing it optimally.
Traditional means of measuring the use of OR time, such as surgical block time utilization, often fail to fully capture how well these scarce and expensive assets are being utilized. OR leaders need a more specific lens to view the details of how well block time is truly being used given a surgeon’s specific practice patterns. They also need to view which time is actually “collectable”, i.e. two consecutive hours that can be reused for cases, while disregarding or eliminating units of 10 or 15 minutes that cannot be reused and that surgeons should not be penalized for leaving on the table.
Hospital and perioperative leadership struggle with optimizing operating room utilization due to a systemic lack of accessibility into open OR time; low to no accountability for how blocks are managed; and poor visibility into key operational metrics.
Providing access and visibility to usable OR time
In the traditional systems and processes of allocating block time, assignments are often made by committee, based on seniority or politics rather than need from surgeons. Surgeons often can’t see what time is truly available in the OR. They know what their usual block time allocation is, but they don’t usually know when there is available capacity they could utilize to schedule additional cases. Surgeons without block time often go through a series of back and forth calls between their clinic and OR schedulers to obtain time.
Additionally, surgeons are asked to release blocks when they don’t have enough cases to fill the time. But in reality surgeons and their offices rarely release blocks because there is no easy way to facilitate the release of scheduled time, surgical offices don’t prioritize the task, and many offices aren’t even aware that they should release the time.
Compounding the situation is that once time becomes available, there’s usually not an effective mechanism to communicate with a hospital surgery center or scheduling department. This leads to the operationally inefficient cycle of calls, texts, emails, and even faxes, which inevitably ends in burnt-out schedulers, frustrated surgeons, patients becoming at-risk as they await needed care, and expensive ORs and equipment sitting idle.
Not only is it too easy for the task of releasing surgical block time to fall through the cracks of a busy work day, but offices and surgeons might be reluctant to give up time if they think they will not be able to get it back when they need it. Many OR schedulers already know which surgeons or offices historically leave time unused, and will place schedule holds for cases (and or “sticky notes” all over their monitors) that they are aware other surgeons are looking to book. Once a block automatically releases a few weeks – or, more likely, days – out from the surgery date, the OR can slot the other surgeon’s cases in.
This process generates added manual work, phone calls, and last minute planning. There are many complexities with managing the schedule in this manner, and there are convoluted rules and extensive manual calculation processes that go into assessing surgical block utilization.
iQueue for Operating Rooms facilitates this process by providing ease of access to open time and highlights repurposable portions of OR schedule time that are repeatedly abandoned, released, or left unused by block owners, and that can be reclaimed without impacting a surgeon’s practice.
Creating accountability for operating room utilization
It is difficult to consistently identify which block owners are leaving large portions of surgical block time unused, let alone hold them accountable for managing their time more proactively. As a result, surgeons distrust the data and are frustrated by not being able to get cases on when they need to, particularly when it appears that there are operating rooms available throughout the day.
The image below is of Collect, iQueue’s module for identifying “collectable time”. Rather than letting the use of assigned block time be ambiguous, this shows a clear day-by-day, block-by-block view of how a particular surgeon is using his time. The green areas represent actual case minutes. The gray areas outlined in red show unused surgical block time in portions large enough to be reused by other surgeons.
For this surgeon, most days contain completely untouched block time and unused capacity, much of it reusable. With Collect, leaders can see how the viable sections of time can be better put to use by other surgeons, while disregarding amounts of time that are too small to be reused. This allows available time to be utilized efficiently without impacting surgeons’ ability to complete their cases.
Visibility into key factors driving operating room utilization
OR performance reporting often takes weeks to compile and months or even quarters to act upon. In order to proactively improve OR utilization, managers and leaders need predictive and prescriptive analytics that are timely, accurate, accessible, and flexible enough to allow a deep dive to drill into specific challenges, root causes, and opportunities for improvement.
iQueue for Operating Rooms provides an easily-accessible, single source of truth to deliver actionable data surgeons and perioperative leaders can trust. Data is approximately real-time and includes rich drill downs, clear visualizations and prescriptive analytics, and capabilities to push key metrics, weekly alerts, and personalized scorecards to surgeons and their offices. As a result, administrators are more confident, surgeons are more engaged, and the system of stakeholders is enabled to have more objective conversations around managing OR capacity.
Achieving results in OR utilization
In the best of times, effectively managing an OR requires resiliency and agility, particularly when flexing scarce resources, managing case backlogs and prioritizing cases. In the aftermath of COVID, these factors were exponentially magnified. Underutilized OR resources are a concern across an entire healthcare organization, and by more effectively managing them, the organization can more efficiently – and more cost effectively – reach its goals. In deploying iQueue for Operating Rooms, for instance, the Washington-based health system MultiCare achieved a 12.4% increase in prime time utilization.
A deeper exploration of prime time utilization, a metric that underlies and drives block time utilization, will follow.