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Using an innovative approach to address critical staffing challenges in operating rooms (Becker’s Hospital Review)

  • Ashley Walsh, MHA

    SVP, Client Services, iQueue for Operating Rooms & Inpatient Flow

Originally published in Becker’s Hospital Review in February 2022. 

Reports from the front lines of hospital perioperative departments show a daily, ongoing staffing crisis.

Short-handed nurses and other personnel are strained to handle the unpredictable capacity demands of their service lines. These critical shortages of both contracted and full-time staff are driving a cycle that increases costs and leads to burn out for existing staff.

Influxes of COVID-related inpatient admissions drive fluctuations of surgical case volumes as well as growing backlogs of deferred procedures. Staffing shortages in operating rooms have increased costs as leaders attempt to supplement with travelers, invest in additional recruiting, or implement strategies for retention, which a recent gathering of leaders cited as one of their top staffing challenges. Existing nurses and others are pressured by growing workloads, which are exacerbated by frequent quarantining due to infection. Early retirements or simple resignations are common.

Rather than attempt to hire and spend their way out of this self-perpetuating challenge, two leading health systems recently and successfully leveraged innovative tools to address and mitigate staffing shortages in operating rooms.

In the height of the pandemic, Baptist Health utilizes backlog management tool to address staffing challenges in operating rooms
The Jacksonville-based Baptist Health consists of five Magnet-designated hospitals, containing over a thousand beds and employing over 12,000 personnel. Their 46,000 surgical procedures are performed annually in a collective 74 operating rooms.

While Baptist Health experienced its first COVID surge in 2020, it faced its largest surge in July 2021. This surge resulted in emergency department (ED) and inpatient beds reaching maximum capacity, while necessitating shut-down in elective surgeries at three hospitals and two ambulatory surgical centers (ASCs) for nearly two months. All non-critical surgical procedures requiring inpatient admission had to be rescheduled. Given the rising backlog, leaders diverted surgical volume to the ASCs. Staffing shortages in operating rooms were exacerbated as personnel were redirected among facilities or quarantined due to infections. Remaining staff were overwhelmed by the number of patients over capacity.

In managing these issues, Baptist Health found that transparent, ongoing, and up-to-the-minute communication was key. Clinic schedulers needed 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. iQueue for Operating Rooms provided a means for schedulers to not only be updated on quickly changing circumstances, but to respond to them by immediately scheduling cases when the right capacity became available.

Baptist Health also partnered with LeanTaaS to develop further capabilities in the tool, including updating the canceled cases waitlist and easily implementing backlog recovery strategies, such as extending hours and revising the block schedule. Once put into practice, these changes reduced extra work for overburdened operating room staff.

This technology support, combined with a community-centered culture that valued collaboration and gave staff opportunities to contribute wherever they were most needed in the organization, yielded an 11.1% increase in Prime Time Utilization (PTU) from Q1 FY21 to Q1 FY22.

Oregon Health & Science University (OHSU) leverages a new tool to effectively manage OR rooms with staffing and resource constraints
The only academic hospital in Oregon, OHSU is also one of only two designated trauma centers in the state and it played a pivotal role in the inception of the Oregon Trauma System. It now performs approximately 36,000 annual surgeries across four surgical sites and 53 operating rooms.

OHSU struggled with inpatient and surgical capacity issues prior to COVID. Oregon is the state with the fewest hospital beds per capita, and OHSU had already accumulated a backlog of over 3,000 surgical cases.

During the 2021 surge of the COVID Delta variant, the post-anesthesia care unit (PACU) was forced to convert to an intensive care unit (ICU).PACU nurses were subsequently redeployed, which cut OR capacity overall. Additional staff expenses increased as anesthesia-qualified MDs increased charges by over 10%, along with higher RN salaries in the state of Oregon compared to the rest of the U.S.

To help existing operating room staff manage the ongoing chaos, OHSU needed to maintain a predictable process of admissions, triage, and block scheduling. With this agreed-on foundation of case prioritization in place, staff could remain flexible and make small adjustments to their spaces and schedules as needed, taking a “chisel” approach of moving staff and open rooms to meet demand rather than a “sledgehammer” approach that overhauled the system and exacerbated the chaos.

iQueue for Operating Rooms supported OHSU with its robust data analytics, which provided an accurate prediction of case lengths from historic averages, enabling schedulers to build the most effective block schedules and assign only the needed staff to them. iQueue also supported ongoing visibility into OR and prime time utilization, along with progress on the backlog, to help identify best practices for staff efficiency moving forward.

Like Baptist Health, OHSU also valued a culture of cross-team collaboration. Staff with transferable skills were sometimes redeployed to areas outside their usual practice to support the whole hospital and system. During COVID surges, for example, OR nurses joined surgical techs and other staff to create “Proning Teams”, which were always on call to assist ICU nurses in repositioning COVID patients to a therapeutic prone position.

For a more in-depth look at how both Baptist Health and OHSU have managed critical surgical staff shortages with innovation, including key takeaways and tools for other providers, view the whole webinar.

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