In health care, the primary constraint in patient care is the availability of scarce resources, and no resources are more scarce than Operating Room (OR) time. Available OR time is often in short supply, and consistently unpredictable demand compounds the challenge of optimally allocating and utilizing that supply.
It is important to understand that optimal utilization is not based on overall room utilization during any time of the day or any day of the week. Rather, it is based on utilization during the facility’s business hours, or its “prime time.” This is the time during which the department is staffed and resources are available to efficiently perform the surgeries. (Cases performed outside of prime time often lead to even greater costs associated with staff overtime and increased inefficiencies.) Simply calculated, prime time utilization is the percentage of available minutes filled with case minutes during business hours, and it is a simple metric that avoids the complications and pitfalls that too often hinder other efficiency metrics.
For most hospitals and surgery centers, a significant portion of prime time hours are allocated through block scheduling on the assumption there is consistent demand from surgeons scheduling cases into the same time blocks week over week. The allocation of these times is typically initiated through a committee and often influenced by politics and seniority rather than surgeon volume. However, surgeons who have blocked time don’t always have the case demand to fill that time, and surgeons with volume lack access to backfill those open periods. As a result, time goes unused, which is reflected in prime time utilization.
Hospital and perioperative leadership struggle with optimizing 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.
Access to OR time
Using traditional systems and processes, surgeons don’t often know what time is available in the OR. They know their block time, of course, but they don’t usually know when there is available capacity they could be utilizing to schedule additional cases. Surgeons without block time often go through a series of back and forth calls between their clinic and the OR schedulers to obtain time.
Additionally, surgeons are asked to release blocks when they don’t have cases to fulfill them. However, the reality is, surgeons and their offices rarely release blocks because there is not an easy way to facilitate the release of scheduled time, surgical offices usually don’t prioritize the task, and many offices aren’t even aware that they should be releasing the time.
Compounding the situation is that once time becomes available, there’s usually not an effective mechanism to communicate with a surgery center or hospital’s scheduling department, leading to the operationally inefficient and often ineffective litany of calls, texts, emails and even faxes.
The good news for administrators and schedulers is that an affordable software solution with a demonstrated return on investment does exist for optimizing scheduling – iQueue for Operating Rooms. This solution offers 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.
Accountability for OR utilization
Not only is it too easy for the task of releasing block time to fall into the cracks of a busy work day, but offices and surgeons might also be reluctant to give up time if they think they might not be able to get it back later should the need arise. Many OR schedulers know which surgeons or offices historically leave time unused, and they will place holds on a schedule for cases 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 is able to slot the other surgeons cases in. This generates a lot of manual work, additional 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 block utilization. As a result, it is difficult to readily and consistently identify which block owners are leaving large portions of 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 shows a day-by-day, block-by-block view of how a surgeon is using her time. With the green area representing actual case minutes and gray areas representing unused, but blocked, time, it’s apparent almost every other day has a completely untouched block and unused capacity. This time could be better put to use by other surgeons without impacting the surgeon’s ability to complete her cases.
Visibility into factors driving utilization
Prime time utilization is a lagging indicator, and once it is low, there is no way to make up for the lost time. Additionally, OR performance reporting often takes weeks to compile and months or even quarters to act upon. In order to proactively improve 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 the metrics in an easily-accessible, single “source of truth” format that delivers 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 measures, 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.
Putting it all together
Solving for low prime time utilization delivers benefits not just to the operating room but also to patients and the entire organization. Patients are able to get their surgeries scheduled sooner, surgical offices have more predictable schedules with fewer add-ons or rescheduled cases, and facilities avoid costly nighttime, after-hours cases, and make more informed capital budgeting decisions around expanding OR facilities.
In the best of times, healthcare providers and practitioners navigate turbulent waters. In times of pandemic, those factors are exponentially magnified. Effectively managing an OR requires resiliency and agility, particularly when flexing scarce resources, managing case backlogs and prioritizing cases. Underutilized OR resources are a concern across an entire healthcare organization, and by more effectively managing prime time utilization, the organization can more efficiently – and more cost effectively – reach its goals.