The University of Kansas Health System (TUKHS) is extensive and growing, with 52 operating rooms that run at nearly-full capacity but only 51% block utilization. Megan Eubanks (Senior Director of Business Operations of Perioperative and Procedural Services, TUKHS) knew the health system had to deploy better surgical scheduling and block management to expand its capacity. As allocation at TUKHS isn’t managed by a single block committee, but by individual service chairs, universal visibility into block management data is a priority.
At LeanTaaS’ December 2022 Transform Virtual Hospital Operations Summit, Eubanks joined with LeanTaaS’ Ashley Walsh to discuss her journey using AI-powered perioperative software to support clarity and efficiency in the TUKHS OR.
Ashley Walsh: I’m excited for you to share your story and your work, how you’ve leveraged technology tools and partnerships, and the great results you’ve seen at TUKHS so far. What are your thoughts on the foundations for surgical block management?
Megan Eubanks: I’m passionate about this conversation, because people often look to surgical block utilization at face value for opportunities to find more OR capacity. Block utilization is thought of as the OR time we grant a service group or surgeon, compared to how well they use that time. But this number doesn’t truly tell us how that service or surgeon is performing.
A surgeon’s block utilization could show consistently at 100%, while that individual’s releasing a lot of their time. Another surgeon could stay at 60% utilization, but they’re a neurosurgeon and their cases are typically eight hours, so they simply don’t have flexibility to use more time. We have to look at all details to make informed decisions on surgeon scheduling, or we risk giving arbitrary block assignments that don’t serve surgeons’ needs.
At TUKHS, our growth is exceeding our capacity. We need to see our average block utilization go much higher than 51%. As a Level I trauma center, we have a significant number of add-ons, and those can only be accommodated if time is released. In the past we’ve depended on surgeons or services with block time releasing it, which doesn’t always happen.
Lack of visibility is the biggest barrier we’ve had to efficiency, especially block time. We needed perioperative software to create that visibility and empower our teams to leverage it. That’s why we chose to adopt iQueue for Operating Rooms.
Walsh: Because of those complications and that lack of visibility, your very high capacity OR system is at half utilization. How do you start addressing those fundamental block management challenges to unlocking more capacity through surgical scheduling, and how does a solution like iQueue support you?
Eubanks: We began implementing iQueue in 2020, then saw a lot of changes with our block structure at the height of COVID. Our goal now is to create a foundation of block management with our relationships to our service chairs and the data for decision support. We focus on OR capacity management overall, making sure we’re using one of our most expensive resources, the OR, as well as we can. The implementation process gave us the opportunity to establish this as a priority.
We don’t have a block committee, but we do have a strong partnership with our service chairs, and we use iQueue as a source of truth to share data with them and help them find opportunities to improve utilization performance.
For instance, iQueue let us easily update how our surgeons were mapped, so it credited utilization appropriately. It highlighted how blocks for all our surgeons and service lines have been consistently released 48 hours prior to the date of procedure, which allowed no time to add cases on. iQueue’s release reminders, my favorite feature and what’s really solidified our success, encouraged earlier releases and longer lead times. We could update the service and surgeon level based on that lead time, and revalidate that all our block assignments were set up correctly.
Using iQueue, our chairs can dive into their department’s performance by surgeon and by location, and surgeons can access their own case-related data. Surgeons like to know what they’re contributing and how they’re performing in terms of late starts, turnovers, and case length accuracy. Our leadership, surgeons, and their schedulers are extremely busy and have found a lot of value in having access to this credible, accessible, and actionable data. It’s fostered an environment of strong communication and processes.
Walsh: That’s so satisfying, and it’s fantastic that surgeons are curious and engaging that way. They want to be part of the process to improve efficiency because they recognize how that gives them more time and makes their results more accurate.
What are the efficiency results you’ve seen so far?
Eubanks: There was previously quite a bit of a misalignment between prime time utilization and block utilization. After a year of implementing iQueue, we’re seeing that line up more, meaning the time we’re granting is being well used. There’s room to grow but overall it’s very promising.
We were able to increase overall block utilization by 20% total, prime time by almost 5% total, and overall volume by 8% – all with a 7% reduction in available room. That indicates we’re using our space much better, which is very important. Then we have a staggering 98% of proactive releases or transfers of time, which is vital to OR access. It’s exciting to see people so much more active in the system.
Walsh: Those are incredible results. I’m fortunate to work with over 50 health systems, and because ORs are full of stochastic events, there will always be a delta between blocks and prime time or staff utilization, or whichever metrics an organization uses.
But maximizing blocks is always the goal. TUKHS is a real testament to improvement in that space, specifically because your blocks are what you depend on for your planned volume, execution, staffing, et cetera.
This also speaks to how well your service lines, being Level I, are actually allocating what is reserved for trauma and acute care surgery, versus what’s reserved for elective cases. I know so many hospitals struggle in that area.
Eubanks: We do have a unique way to allocate blocks. Our chairs manage their blocks really well, and are very engaged in the process. To be able to be a hundred percent allocated and still maintain surgical scheduling space for add-ons and trauma is pretty significant.
That said, we aren’t done. Our leadership always says that we’re proud, but never satisfied, here at The University of Kansas Health System. We’ve barely scratched the surface on what we can do with our partnerships, with block management, and with the functionality of iQueue.
Working with the team at iQueue has also been a valuable partnership. We look at opportunities we can develop together. There’s more functionality in iQueue that we could use to help us use and manage our blocks here, like identifying which underutilized time is truly “Collectable” and reusable. I’m excited to really get started on that in the next few months.
Walsh: Partnerships are so important. When I worked in perioperative services myself, I evaluated third party partners to enhance operational efficiencies. Now I work with this amazing iQueue team because I believe more of these partnerships need to happen to help improve and sustain operations.
At LeanTaaS, it’s tremendously important to us that our health system partners see value like TUKHS does. We appreciate hearing about your journey and fantastic results.
For a deep dive into the functions of iQueue in supporting block management, and TUKHS’ step-by-step process in applying them, find the full Transform session here. To learn more about iQueue for Operating Rooms, visit our page here.