47% more surgeries are now on time
Other studies show ways to save money, improve care
Implementing a system to ensure the surgical team uses the most effective practices resulted in significant improvements in operating room (OR) performance, suggests research being presented at the American Society of Anesthesiologists' (ASA) Practice Management 2014 meeting.
Research presented at the meeting includes:
Improving efficiency in the OR. OR performance improved significantly after implementation of a system that ensures surgical team members understand and use proven effective practices, according to a study at the University of Pittsburgh Medical Center. Two years after implementing the system in six hospitals, researchers measured a 47% improvement in on-time starts, a 64% improvement in surgical incision time, and a 12% improvement in turnover time.
Poorly managed ORs can lead to excessive cost in the delivery of care as well as low patient satisfaction due to unnecessary wait times, according to lead author Trent Emerick, MD, anesthesiology resident, and senior author Mark Hudson, MD, MBA, associate professor and vice chair for clinical operations. Standardizing OR procedures increases awareness among OR team members of areas needing attention, which led to significant improvements, Emerick said.
Reducing overstock. By applying supply chain theory to one item alone, researchers at the University of Texas MD Anderson Cancer Center -- Houston calculate the center will save $21,500 during the first year of implementation and $15,500 in subsequent years.
To conduct the study, researchers chose the Arrow 12 Fr. Triple lumen central venous catheter, used in surgical cases in which rapid infusion of blood or blood products is anticipated. Although these procedures typically are scheduled in one of five specific ORs, the catheter was unnecessarily stocked in all 30 ORs and the ambulatory care center. Because the catheters expire, overstocking leads to waste, notes lead author Charles E. Cowles Jr., MD, MBA, assistant professor of anesthesiology and perioperative medicine. Calculating how many catheters would be required, including factoring in ordering time, researchers determined only 10 catheters should be stocked, whereas the hospital had 49 in stock. Savings would be significant if the supply chain theory is applied to the thousands of items overstocked in facilities nationwide, researchers note.
Decreasing possibility for fire. Fire usually doesn't top the list of potential OR concerns, yet about 600 surgical fires occur in the United States every year. More than two-thirds of these fires are caused by electrosurgical equipment, and the use of supplemental oxygen is a factor in most cases.
To reduce or prevent OR fires, anesthesiologists and other surgical team members at the University of Florida, Jacksonville, focused on improving policies, education and training, as well as communications to create a culture of safety. The group developed a tool to identify patients at high risk of experiencing a surgical fire and employed other risk-reduction strategies, including electronic prompts with the electronic medical record, periodic fire drills, and education of surgical staff members, said lead author Linda W. Young, MD, MS, UF Health, Jacksonville. Researchers still are tabulating the data, but they have noted a reduction in incidents due to the increase in awareness and adherence to the protocol.
Comparing benchmarking data from different facilities. Being able to benchmark clinical productivity allows anesthesiology groups and hospitals/facilities to identify areas for possible improvement. But it is important to compare the benchmarking data of similar facilities to provide meaningful comparisons.
Researchers from several institutions surveyed the members of the Association of Academic Anesthesiology Chairs about anesthesiology clinical work by facility. This survey resulted in benchmarking data based on 143 facilities accounting for more than 2.5 million cases. Comparing like facilities, the results showed that shorter surgical duration at children's, community, and smaller facilities led to more units billed per hour of care, which resulted in fewer billed hours for similar productivity per OR, said lead author Amr Abouleish, MD, MBA, professor of anesthesiology at University of Texas Medical Branch, Galveston.
Standardizing preoperative evaluations. To improve care, lower costs, and reduce morbidity and mortality, Georgia Regents University in Augusta developed protocols for the creation of a "surgical home," including computer-assisted health screening questionnaires for various scenarios.
With the increasing focus on the surgical home concept, which facilitates coordinated and integrated care, the goal is to standardize preoperative evaluation to ensure careful triage and appropriate treatment as well as decrease unnecessary actions. For example, the protocol guides nursing and anesthesia staff on tests and measures needed before surgery and clarifies which medications patients should avoid on the day of surgery. About 65% of hospital expenses are due to morbidity and mortality, and administrators anticipate the cost of the new system will be offset by savings from minimizing redundancy, avoiding surgery delays and cancellations, and improving reimbursement coding, said lead author Mary E. Arthur, MD, associate professor in the Department of Anesthesiology and Perioperative Medicine.
The ASA has committed more than $500,000 in support and scholarship to jumpstart the development of a learning collaborative of health care organizations working to improve surgical care through the Perioperative Surgical Home (PSH) model.