Webinar Transcript: Doing more with less – WakeMed’s experience in optimizing surgical capacity

At the Winter 2021 LeanTaaS Transform Hospital Operations Summit, John Peterson, Business Manager of Perioperative Services for WakeMed Health, and Ashley Walsh, Vice President of Client Services at LeanTaaS, discussed WakeMed’s implementation of iQueue to optimize surgical capacity and volume.  

You can view the whole webinar on the Transform Perioperative track page. 

Moderator: I want to turn the floor over to Ashley and John from WakeMed, to discuss how iQueue for Operating Rooms has impacted WakeMed Health and their hospitals. 

A quick introduction before I turn it over to them. John Peterson is the Business Manager of Perioperative Services for WakeMed Health and Hospitals in Raleigh, North Carolina. He’s worked in healthcare for nearly 20 years. For the last 10 years, his work has focused on operational financial management at the WakeMed Raleigh campus, which is an urban Level One Trauma Center in Raleigh. His teams provide the daily clinical operations, or supports the daily critical operations by providing scheduling, inventory, billing, and clinical informatics support needed to care for over 20,000 patients annually. 

Ashley Walsh is our Vice President of Client Services at LeanTaaS, leading collaborative efforts with over 30 healthcare organizations to develop, introduce, and implement high ROI predictive analytic solutions that help increase patient throughput, improve satisfaction for both patients and staff, and reduce service delivery costs. She oversees both the OR and beds product and sales teams and implementations. She’s been especially instrumental in the development and advancement of the iQueue for Operating Rooms platform. So I’ll go ahead and turn the floor over to Ashley. Take it away. 

Walsh: Great, thanks so much, and John, so happy you could join us here today. I know the audience is excited to hear from you. So with that, let’s just jump right in. We’d love to know a little bit about your experience and why WakeMed was really looking to partner, perhaps with a third party vendor, or what you were looking to optimize at the time. 

Peterson: Well, several years ago, we were running into some specific issues surrounding volume. Our surgeons were not wanting us to close operating rooms, so we had too much capacity available. We needed some sort of third party to provide an unbiased view of our data, something that the physicians would be able to latch on to, that they would accept. Part of that challenge was the cost of those rooms being open without those cases. 

Walsh: But you had the staff, actually, is that right? That what I’m hearing correctly, 

Peterson: We did have the staff available and the rooms were open. We had estimated that our cost per year was about a million and a half dollars. From the time that we started looking at iQueue and from the time that we ended up going live with iQueue, the situation had changed. We had additional providers that were on boarded, and demand for operating rooms increased. We were no longer looking at a partner to really look at reducing available OR time, but then we were looking to increase our OR time. 

Walsh: But you were in a unique situation where you were overstaffed for a period of time and didn’t have that demand, and then that demand started flooding in and you had to kind of re-pivot. That’s interesting. So let’s transition that into the last 18 months, because I’m sure you yet again had to pivot. So what was that like really at the beginning? I mean, we’re very much still in a pandemic, but at the beginning of the pandemic, on how you had to reposition, and what were your capacity challenges and how did you, where did you focus on optimizing? 

Peterson: As an urban community hospital system, we had to look at challenges with influxes to our inpatient floors. We’ve had three separate periods of time where we’ve had to try to reduce certain types of cases in the lease or reduce cases altogether. So our time sensitive case volume, of course, never went away because we are a trauma center. But for the non-time sensitive cases, we did need to have some adjustment to our schedule so that we could provide those patients who needed those four beds. And what we ended up doing is utiliza iQueue to provide frontward facing messaging to our providers and our office schedulers that are outside of our EHR and so they were able to then triage patients based on our requirements, then either put off cases that could be delayed just a little bit until we were able to have bed space available in the house, or conversely, we were able to have them schedule cases that were really time sensitive and those patients needed that care. 

Walsh: So I do remember you were one of the early adopters on kind of triaging. Looking at that backlog, through the tools that are presented through iQueue, and so what were you doing on a daily basis? Obviously, you had to triage facing the provider offices, which is great. And then how did you handle that internally? I’m assuming you then had to do that multiple times. As you mentioned, you’ve had different waves of changing your elective surgery volume.  

Peterson: We have had to do that on a daily basis. We had our physician leadership as well as our clinical leadership looking at our available ICU floor bed space that we typically would use for post-op care. And they were making decisions on a daily basis on how many events we could do. It was a painful time for not only our patients, but for our providers as well. They really were wanting to take care of their patients. Unfortunately, we were just struggling just as most community hospitals were at those times. 

Walsh: So shifting gears again, John: what does it look like today? How have your needs changed as an organization? Where’s the focus for optimizing your capacity? I’m sure you’re still being faced with some challenges from time to time with inpatient capacity constraints, but where’s the primary focus for you and perioperative services and how are you meeting those needs? 

Peterson: We are moving into our busy time of the year, as we all experienced during that last quarter of the year, and interestingly enough, the demand that we’re continuing to see is higher than years previous. So now we’re looking at trying to get back to some sort of normalization and trying to expand where possible our daily hours. We are seeing an increased demand from surgical offices, where we’ve also added additional providers of community and physician aligned with the hospital system, those practices that are aligned with the system. So it’s creating some challenges for us. As we are trying to put as many cases on as possible during our normal business hours. But at the same time, we’re dealing with some staffing challenges, just like those facilities are around the country right now. And so we want to make sure that we’re operating our staff out but we’re still able to provide services that those patients need. 

Walsh: How do you do that day-to-day, I think the audience would love to know, you know, what tools have been helpful. Where have you seen the biggest benefit to those day to day changing needs in addressing them? And then how do you continue to shift and pivot? 

Peterson: Well, for example, we’ve been able to add on some additional capacity on our weekend. As a trauma center we usually have cleanup on Monday mornings. We work with our providers to both anesthesia and the surgeon providers to be able to do additional cases on the weekends. So we were no longer trying to shift cases to Monday morning for cleanup, but then we were able to keep that space open for the elective cases that we did two per at that time of year. It’s been beneficial because patients end up going home earlier, who typically would have waited for their surgical care early in the week. Now those cases can occur Saturday or Sunday. So we’ve been able to shift that direction as well. We’ve also expanded some of our case volume availability in the late afternoons and the early evenings. So we’ve expanded some of our room times to be able to allow additional procedures to occur or traditionally, we would have had to tap those cases off and not perform them. 

Walsh: And you’ve got a mix right of employed and community based providers. Is that true?

Peterson: That is true. We are primarily employed at this facility. But we do have a number of community providers who use us as their primary location for surgical care. 

Walsh: I think the last time we chatted actually you were sharing with me how within your organization you’ve looked to start shifting some volume from location to location just based on various needs. Can you talk a little bit more about that? What are those needs? And then what has been effective in communicating to the providers the different availability of surgical locations that are available for them? 

Peterson: iQueue in our community has been extremely helpful, especially for community providers who don’t have access to our internal view. They’re able to see availability across multiple facilities, not just within our system but also within a neighboring system as well. So they’re able to see OR availability and be able to select times that fit their schedule as well as their patient needs, which is fantastic. And then internal to our system, iQueue is able to help those providers be able to get cases where they may have to either delay care for a patient or take the patient outside of our system. So that’s extremely helpful. Some of our providers have moved cases from one facility to one of our other facilities that might have time available as it’s convenient to them. It’s fantastic for continuing that patient care without having any of those difficult discussions with patients or subsequent patient complaints. 

Walsh: How about overall volume – where are you today compared to say 2019, 2020? What has that shift looked like for you? 

Peterson: The shift has actually been quite dramatic. When we went live with iQueue, this would have been the last quarter of 2019. We actually saw a four and a half percent increase that first quarter on this campus without having to expand any available time on our grid. We didn’t add any additional staff, any additional assets in terms of rooms. 

Walsh: So that staff that was there, just kind of waiting in the wings, before we were able to repurpose with the additional wait and demand and keep the same hours. That’s pretty significant, because a lot of times when you start getting that influx of demand, we often in ORs jump to increase operating hours right out of the gate. But it’s wonderful you were really able to absorb that volume. 

Peterson: That is very beneficial to the system, because we end up being able to have additional revenue without much additional cost, outside the supplies and implants that we’re going to use on those cases. Traditionally, staffing costs are the most expensive for hospitals. So that’s been a big win. Then now, as we’re kind of coming out of this last wave of the pandemic here locally, we’re able to continue that additional throughput for our patients and so we’re able to do as many cases as we possibly can. 

Walsh: That’s fantastic. I know you’re a very data-driven culture there. How have you expanded into your non-OR locations? Looking at data accountability, what are some things that you’re doing in some of those? Endoscopy, Cath, etc. 

Peterson: You mentioned it already. We did expand iQueue into our Cath Lab, EP lab and our endoscopy areas. This has been a systemwide push, and it really has helped our partners and our leadership, both Physician and those in the C-suite, to be able to have an at-a-glance view of operations on a daily basis. Typically for us, we had a little bit of delay between the time that the stats come out or the operational metrics come out. Then there’s always the reaction by the leadership to be able to try and correct something that may be amiss. Now with the state of transparency across the system across these various key procedural areas, leadership is able to give guidance, and then we’re also able to provide data transparency, not only for the physician partners, who we partner with in each of those areas, but also with the physician leaders of those practices. That’s very key and bringing physicians to the table to make change where change is needed, and to be able to improve operationally not only for the organization, but also for patient satisfaction, which is fantastic and is very key in order to meet our H-cap and continuously improve. 

Walsh: At WakeMed, is your leadership for all of your procedural areas under one umbrella or different umbrellas? 

Peterson: We’re underneath different umbrellas based on the facility. So we do have a dyad partnership structure, where we have a physician leader and a C-suite leader over each facility. That does provide some clinical background to decisions made on a daily basis, by sharing information and data with those leaders, as well as with our key stakeholders. Each of the  procedural areas it really gets to move the ball forward and making change and changing culture where needed. 

Walsh: I asked that question because I love to see the response of different departments, different leadership teams talking really the same talk through a single source of truth and focus when it comes to data. Because when there’s disparate systems that can sometimes lead, I don’t know what your experiences, but mine when I was in the hospital was it could lead to more challenging conversations than when we’re all really looking at one source of truth for analytics. So hopefully that has been helpful for you at WakeMed as well. 

Peterson: Absolutely, it has been exceptionally helpful and has started to break down silos and it provides a broader view to everyone. We’re not trying to hide anything, we want to make sure that data transparency is in the forefront and so that changes that need to occur can occur as quickly as possible. 

Walsh: That’s great, thanks. You know, technology can be overwhelming. There’s a lot of different technology offerings out there. There’s a lot of different places we can actually focus in the healthcare systems to improve efficiencies. I’d love for you to share any lessons learned that you’ve had along the way in making a decision to partner with a third party for analytics challenges, where the focus is and how it’s helped you. 

Peterson: It absolutely has helped us. One of the most important areas we have identified going into partnering with iQueue is making sure we have standard definitions to some of these analytics, for example first case starts. Our physician leadership has identified, when we have that same definition across the procedural areas, across the facilities, that the expectation then is known and can be set to say, “when this case starts, this needs to be on time.” So we’ve standardized that definition and it is really driving change and improvement in many areas. And that has a subsequent ripple effect, downstream for your secondary and tertiary cases that end up occurring during the day. That first case start is key to improving your case starts in the afternoon as well, because you no longer have that delay that you’re waiting for that case to start. 

Walsh: Well, thanks for sharing that John. More importantly, thank you for spending some time with us today here. We’d love to ask a last question, to know a little bit about the focus going forward from here for you at WakeMed, looking to 2022 and to get through this last quarter here of 2021.

Peterson: Moving forward, and what’s been going on the last 18 months, has been trying to say the least not only for us, but for our community, patients and really with a lot of our patients who weren’t comfortable with having a surgical procedure completed during the pandemic. Then being able to now open up in the community and make sure that they have the care that they need, when they need it, is absolutely key. Our patients are our utmost priority. And iQueue has been able to help us to do that by significantly improving our visibility and communication with our physician. Community physicians are able to see what’s available across multiple facilities, so they can see our OR time very clearly. That is very, very important to us, so we can partner with the providers to be able to take care of the patient. At the end of the day everything that we do really surrounds that patient, and we want to make sure that we give the best possible care to our patients. 

Walsh: I couldn’t agree more, thanks for sharing that, and I certainly have appreciated the partnership with WakeMed. It’s definitely a priority of ours here at iQueue to make sure we can help organizations be as efficient as possible with not only their perioperative time, but the staff, the anesthesia providers, and meet the needs of your patients in the community. So John, thanks so much for taking time this morning. I know the audience appreciated hearing from you.