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IRVING, Texas -- Operating rooms (OR) are important centers of patient care and hospital revenue, but a significant portion of OR time is consumed by non-operative activities. To improve care and enhance revenue opportunities, hospitals need to make improving operating room efficiency a high priority. In spring 2006, VHAs regional office in Indianapolis, launched an initiative to help hospitals improve clinical practices and patient care in the operating room. Twenty-nine hospitals from Illinois, Indiana, Michigan and Ohio joined the VHA national initiative through the regional office.
This OR initiative is part of VHAs overall push to help members become best performers and to improve clinical quality.
"VHA helps its members deliver the highest value to its patients. This OR collaborative is one more example of how a focus on the patient leads to results," says Trent Haywood, MD, chief medical officer at VHA, a national healthcare alliance.Â
By working together in this OR project through VHA, the hospitals improved their operational practices in three areas: preoperative activities, intra-operative activities, and post-operative activities.
Hospitals lose revenue each year due to inefficiencies in the operating room, says Carol W. Birk, RPh, MS, director of performance improvement at VHAs regional office in Indianapolis. We launched this program to bring hospital OR staff together and openly address common challenges, explore solutions and implement changes.
Common issues that effect OR processes and impede efficiency include: lack of physicianÂ compliance with first-case start time, space and facility design, scheduling staff education, physician office chart documentation, utilization of patient pre-admission testing and the number of steps it takes to prepare the OR for each new case following surgery, referred to as room turnover.Â Â
Each of the participating hospitals addressed these issues differently. Many of the hospitals showed improvement across all three of the areas they addressed.Â For example, 34 percent of the hospitals reduced pre-registration time, getting patients in the operating room within five minutes of scheduled first-case start time. This improved start time accuracy and obviously improved throughput time, which enabled the hospitals to perform more surgical procedures. Ultimately, this generates more revenue for the hospital, but it also improves the patient experience, since they dont have to endure delays.
Spectrum Health United Memorial in Greenville, Mich., was preparing to relocate its OR department, including its same-day surgery suites, outpatient offices and patient suites, and its OR staff did not want to bring the old ways into the new facility. Through its involvement in the VHA program, Spectrum decreased the time from patient arrival in the preoperative area to transport to the OR suite from 104 minutes to 90 minutes; increased the number of pre-procedure phone screenings to 90 percent; increased first case of the day start times by 65 percent; reduced room turnover time at or below 20-minutes; and decreased phase II recovery time by 17 minutes.
We joined the collaborative to glean best practices from other hospitals, says Patty Shoults, RN, BBA, MBA, director surgical services at Spectrum Health United Memorials campus. We have significantly improved our process from the point a patient is referred to our surgical services to the point when the patient leaves to go home after surgery.
Columbus Regional Hospital in Columbus, Ind., focused on changing the culture and environment in its surgical area to improve operations. Practice changes were driven by stringent data analysis, as well some newer methodologies, including Lean Six Sigma and Kaizen. In addition to improving its pre-registration (by 20 percent) and chart documentation (14 percent) processes, the hospital saw an 8 percent improvement in getting patients in the operating room within five minutes of the scheduled first-case start time.
We appreciated communicating with peers about success, struggles and ideas we are all working on in the OR through the VHA initiative, says Kim Reed, RN, outpatient surgery manager at Columbus Regional. Seeking out everyones opinion regarding OR changes and improvement opportunities and making sure people knew their voices were being heard is the key to our success.
By eliminating operational inefficiencies and frustrations, we are enabling the physicians and nursing staff to focus on the important issue of providing patient care, Birk adds.Â Thats why this program is vitally important to our members.