The Cutting Edge

What’s the Secret to a High-Performing Surgical Department?

What’s the Secret to a High Performing Surgical Department? No, it’s not a trick question – there is an answer.  But the truth is, it’s not an easy answer.   It requires Focus, Accountability and Data.  Or stated another way, it requires leadership, measurable goals and information.   

As a healthcare executive, before you contemplate diving in to an operational improvement project in Surgical Services, you might ask yourself: Will the return be worth it?  Let’s face it; there are a lot of moving parts and really smart people in Surgery.  You’re probably thinking, “Do I want to be messing around in their business?  

If you answer yes to any of the following needs, then it’s time to visit your Surgery Department for a little heart to heart:

•    Improving patient satisfaction
•    Attracting and retaining top surgeons
•    Generating additional revenue
•    Reducing costs

But before you head over there, let’s make sure you are prepared with a game plan.

Focus

Sustainable improvement will require on-going time and attention so before you get started take some time to understand what your biggest pain points currently are in delivering surgical services.

The most common areas to start with are:

•    OR block utilization
•    First case on time starts
•    OR turnover time
•    Staff overtime
 
But every organization is unique.  So understanding what is and isn’t working today, will guide your efforts.  And remember, it’s okay to start small and build on your successes.  Top down leadership is the first component of building sustainable perioperative improvements.  

As you gather a baseline on your organization’s current performance, you can begin to set incremental improvement targets.  Plan to go into the project knowing that you will likely not have all the data you would like to make decisions.  Many organizations will have to start capturing and monitoring data to build a baseline.  There are industry standard ranges for OR metrics that you can use as guideposts in the interim.  Appreciating the uniqueness of your surgical services environment and team will help you guide this transformation, and keeping an eye on the results of all of this hard work will keep you and your team motivated.

Accountability

This might be your biggest challenge.  Surgery is complex so don’t let that remove accountability.  This will be hard, grassroots work as you engage many stakeholders, including your Chief of Surgery, Chief of Anesthesia, Perioperative leadership, Nursing Managers, and OR staff, just to mention a few.

Involving these critical team members early in the process to help build the initial targets and establish the baselines and goals builds buy-in and accountability.  Creating a dashboard to track your results -- whether it is on paper, in Excel, in a report, or in an analytics dashboard -- will help to ensure your performance  measurements and improvement activities remain top of mind.

Each of your key stakeholders likely has a standing weekly meeting, and incorporating a review of the current status and metrics into the agenda encourages  ownership and understanding among the team, provides a forum for questions and answers, and fosters on-going improvements.  Your teams will be working hard to deliver outstanding care while paying attention to the root causes of delays, increased costs, etc.  Dashboard results and information will help them build a cycle of measuring, adjustment, and measuring again into their processes, while working to institutionalize changes that are working well and repeatable. Don’t be a stranger in this process.  Understand the meeting schedules and be sure to stop by and lend your support for this focus.  Be open to their improvement ideas, which will come in many flavors including scheduling changes and system needs.

Once the perioperative teams understand that this is not a short-term project or focus, it will gain momentum.  Your dashboard will move outside of the meetings and into the OR department – often by posting the week’s targets and progress in very visible places throughout the OR.

Data

As you kick off the project, you will quickly understand what data you have and identify potential areas for improvement.  There is an abundance of data available throughout this process and scheduling and clinical documentation are key focus areas for your teams.  Your organization will be at some point on the journey to a complete electronic perioperative record.  Whether you are using electronic nursing documentation and moving to electronic anesthesia documentation, or still documenting on paper with plans to implement electronic documentation, this process will quickly highlight areas where workflow, efficiency and communication can be improved. Having a strong data foundation will be a key to sustainable perioperative operational improvements.

Once you get going your conversations will quickly become focused around what the data says and how to make adjustments – whether that is working with surgeons to modify block times for better room utilization or knocking out reasons for first case start delays.  So the goal of building a trusted data source will underpin your entire program.

Hospitals that can quickly get this data into the hands of their teams, while it is still fresh in everyone’s mind, create a nimble culture that can make rapid improvements.

So, the secret to high performing surgery departments comes down to access to data, and hard work supported by hospital leadership’s ability to instill focus, and accountability into the process. 

Perhaps Amy Smith, AVP of Perioperative Services from Robert Wood Johnson University Hospital said it best at a recent industry conference, when she stated, “It can be done through discipline, executive leadership, and good data!”  

Are you up to the challenge?

 

Ed Daihl has dedicated the past 20 years to successfully building software and technology services companies, and turning them into world-class solution providers. Ed currently serves as CEO of Surgical Information Systems (SIS), a leader in perioperative IT. Ed has also served as executive vice president of revenue management and pricing with Manugistics, a leading provider of enterprise revenue management, pricing and supply chain software solutions. Before Manugistics, Mr. Daihl was president of CAPS Logistics, a provider of network design, routing and optimization software solutions and he also served as a management board member for Baan Corp.

To see how other hospitals are achieving success in their surgical departments, check out the recipients of the 2013 SIS Perioperative Leadership Awards.

 

News for the Perioperative Professional: 04/26/13

Preventing Surgical Errors - Your Role (Part 2)

From the AORN Newsroom: Understanding your role in preventing surgical errors is a key step in promoting better practices for protecting patients.  In this series, learn more about the roles, functions, and responsibilities for the prevention of surgical errors for four perioperative professional positions: administrator, educator, circulator, and OR manager.  

Anesthesia Type Affects Perioperative Outcomes in Orthopedic Surgery Patients

From the American Society of Anesthesiologists (ASA) Newsroom: With hospitals and health systems beginning to be scrutinized on quality metrics highlighting patient outcomes in the perioperative process, care providers are investigating ways they can make a positive impact on surgical results.  The May issue of Anesthesiology describes a study which discovered that spinal or epidural anesthesia were associated with fewer postoperative complications and death than general anesthesia in patients undergoing primary hip or knee replacement.

New Evidence Prompts Update to Metabolic and Bariatric Surgery Clinical Guidelines

Among the most studied surgical interventions in medicine, guidelines for who should have bariatric or metabolic surgery are changing based on significant new scientific evidence published over the last four years.  New insights, cautions and best practices based on the thousands of studies has prompted three major medical societies to change their guidelines, which cover 74 evidence-based recommendations, including patient screening and selection, pre- and post-operative management, selection of surgical method, and criteria for hospital readmission after surgery.

UAB First in US to Test New Emphysema Procedure

A new therapy, designed as a potential method of reducing lung volume in patients with severe emphysema, recently underwent its first test in America at the University of Alabama at Birmingham (UAB).  The AeriSeal System treatment, which uses a foam sealant sprayed into the lungs, is approved for use in parts of Europe and Israel and is undergoing investigation in the United States.  UAB is part of an international phase III trial of the therapy aiming to enroll 300 patients in Europe, Israel and the United States.

Recent posts from The Cutting Edge

Careers in Healthcare Information Technology: Nursing Informatics 101
The job outlook for the nursing field is projected to grow by twenty-six percent from 2010-2020¹ and is considered a faster-than-average growth field. Technological advancements are a major source of that growth, and as technology moves forward, the field of Nursing Informatics is bound to become more and more essential to providing safe, efficient, and cost-effective care.

Perioperative Analytics: Best Kept Secret or Competitive Edge?
The foundation of any successful analytics endeavor is comprehensive electronic documentation.  As the old saying goes, if you put garbage in, you get garbage out.  Laying a fancy dashboard over bad or incomplete documentation gets you, well, bad and incomplete analysis.  So, one of the first places innovative hospitals have applied analytics is to help improve their documentation.

Careers in Healthcare Information Technology: Nursing Informatics 101

What do you need to know to enter the growing field of Nursing Informatics?

This is the first of a two part series on Nursing Informatics. Part 1 focuses on the basics of tnursing informatics field. Part 2 will examine the application of this informatics knowledge.

Information Technology encompasses not only computer and computer systems but other information distribution technologies such as television and telephones. The operating rooms of today are already leveraging technology for advancement and support of patient care. Surgeons are using Xbox Kinect during surgery to help them scroll through medical images without scrubbing in and out. This year’s HIMSS Intelligent Hospital Pavilion showcased new technology that helps OR Directors access the current status of every OR in the surgery suite on a mobile device, such as an iPad, all at once.

The job outlook for the nursing field is projected to grow by twenty-six percent from 2010-2020¹ and is considered a faster-than-average growth field. Technological advancements are a major source of that growth, and as technology moves forward, the field of Nursing Informatics is bound to become more and more essential to providing safe, efficient, and cost-effective care. 

According to HIMSS, Nursing informatics is “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.” But what do you need to know if you want to enter this field?

In this post, we will go over some very basic components of computer systems and their function.

Conventionally, a computer consists of at least one processing element, typically a central processing unit (CPU) and some form of memory. Larger and more powerful machines are considered “Supercomputers” while your SmartPhone is also classified as a computer. Major items of equipment and their components make up hardware on a computer and include input devices, output devices, processors, and storage.

CPUs: The Brains of Your Machine

The hardware within a computer is the Central Processing Unit. It acts as the brain of the machine, carrying out your input and output. It decodes and executes machine instructions by communicating with the input, output, and storage devices.

Input Devices versus Output Devices

An input device is used to provide data and control signals to an information processing system. Keystrokes from a keyboard type out sentences or perform commands. A barcode scanner can tell a clinical documentation system what materials are being entered in a single click. Speech recognition software provides voice-driven, hands-free communication.

The results of data processing by a computer are shown by output devices. A monitor displays information on a screen, a printer prints it; and graphics, images, and audio are created as a result of what was given to the computer by the various input devices.

Storage Wars

Computer storage is classified as primary or secondary. Primary storage signifies the internal memory of a computer as is either Random Access Memory (or RAM) or Read-Only Memory (or ROM). Random Access Memory allows the computer to read data quickly to run applications and is easily manipulated, but is only temporary storage. Read-Only Memory’s contents remain even after a device is switched off, however as “Read-Only,” it cannot be easily manipulated.

Secondary storage is external to the machine and includes items like diskettes, zip drives, external hard drives, jump drives, and cloud technology. There are several advantages to secondary storage as it provides easy scalability, mobility, and convenience. However, these items can be lost or even corrupted easily.

Operating Systems

Managing the computers’ resources are the operating systems (OS), which establish a user interface between the application software and hardware. A computer’s OS executes and providers services to application software. Operating systems include DOS, OS/2, Unix, VMS, VM, Macintosh, Windows, and the open-source option Linux.

Software Applications

How do you get a computer to perform useful tasks? Application software connects the power of a particular computing platform or system software with a particular purpose. Software can be commercial or consist of homegrown systems developed in-house. Software can include email, graphics, word processing, spreadsheets, or software for clinical documentation.

Utilities

Utilities are programs that perform very specific tasks that are usually related to management systems and resources. These can be virus scanners, pop-up blockers, defragmentation solutions, or OS updates.

Now that you have a basic understanding of the components of computer technologies, keep an eye out for the next post in this series, where I will discuss newly emerging computer technologies in nursing and how they can impact patient care.

 

With more than 35 years of nursing experience and the majority of those in the perioperative arena, Marion McCall, BBA, RN, CNOR, CPHIMS, is recognized nationally for her knowledge and expertise in the perioperative field with a focus on nursing informatics and health care information technology. She currently serves as a member of the AORN PNDS taskforce and is the Chairperson for the AORN Perioperative Nursing Informatics Specialty Assembly group. In the changing arena of electronic health records she serves as a clinical mentor to those implementing and struggling with the move to perioperative electronic health records. Marion currently serves as Vice President, Clinical Solutions Group for Surgical Information Systems.

¹ Bureau of Labor Statistics

Perioperative Analytics: Best Kept Secret or Competitive Edge?

Innovative hospitals have been using perioperative analytics for years.

Hospitals grappling with how to implement an ACO and adjust to new outcomes-based payment models are jumping on the Big Data bandwagon.  It appears that many CIOs, always looking to streamline their IT and vendor stack, are contemplating going down the same old road again, one of trying to put in a single technology solution and trying to make it work for everyone. 

That would be a shame and potentially could undo years of hard work that has quietly been helping top hospitals become even better.  While I certainly appreciate this big picture vision and its need for an aggregated data warehouse, analytics targeted at solving very specific, very challenging problems should not be pushed to the side in the process.  Particularly with the implementation of Meaningful Use driving standardization which will facilitate the sharing and combining of data sets for use, for example, to target large population and disease management challenges.

The foundation of any successful analytics endeavor is comprehensive electronic documentation.  As the old saying goes, if you put garbage in, you get garbage out.  Laying a fancy dashboard over bad or incomplete documentation gets you, well, bad and incomplete analysis.  So, one of the first places innovative hospitals have applied analytics is to help improve their documentation.  In the Surgery Department, comprehensive documentation of the surgical event enables healthcare providers to use analytics to:

• Help meet regulatory and compliance reporting requirements
• Identify process changes that can be used  to improve key metrics like on-time case starts and room turnover times
• Understand true costs and have fact-based conversations with surgeons around devices and outcomes
• Validate clinical documentation to better allocate appropriate DRG or ICD-9 codes

There are some truly innovative hospitals out there that are quickly gaining a competitive advantage.  By focusing on high risk, high impact areas like surgery, they are using perioperative analytics to help them solve one challenge after another.  The pace of change in healthcare is not going to slow down, so ensuring that revenue generators like Surgery have the tools they need to succeed gives hospitals a competitive edge.

Perioperative analytics is also quickly evolving from a historical view, even if that means yesterday, to a current, today view, with the applications helping healthcare providers make adjustments near real-time that impact that day.  So, in Surgery, being able to predict the need for overtime or the best way to accommodate add-on cases makes a difference in care delivered, costs and staff satisfaction. 

Additionally, hospitals can use their model for analytics in the perioperative department to expand their enterprise BI effort, leveraging lessons learned from their departmental strategy.

So, it’s no longer a secret and where perioperative analytics will go is only limited by the imaginations of these innovative healthcare providers.  

Ed Daihl has dedicated the past 20 years to successfully building software and technology services companies, and turning them into world-class solution providers. Ed currently serves as CEO of Surgical Information Systems (SIS), a leader in perioperative IT. Ed has also served as executive vice president of revenue management and pricing with Manugistics, a leading provider of enterprise revenue management, pricing and supply chain software solutions. Before Manugistics, Mr. Daihl was president of CAPS Logistics, a provider of network design, routing and optimization software solutions and he also served as a management board member for Baan Corp.

 

News for the Perioperative Professional: 04/12/2013

8 checklist mistakes to avoid
From the AORN Newsroom: Atul Gawande's surgical safety checklist research team is in the third wave of a project designed to get an effective surgical checklist used in a consistent, meaningful way in every operating room. Starting in South Carolina, the project members are providing OR teams coaching for checklist implementation to help them avoid mistakes and reach checklist success. 

PQRS and Anesthesia: Getting On Board with Quality Reporting

This is the second part of a three-part series. Part 1 provided a checklist for setting up a quality program. Part 2 focuses on how to collect and report quality measures. Part 3 will examine the role that information technology plays in quality reporting systems.

The change from fee-for-service to pay-for-performance reimbursement models has many anesthesia providers nervous—not only because of the potential financial impact, but also out of fear that the data could be misused. They may envision individual performance metrics being used against them in hospital negotiations or being displayed in a public forum for the world to see.

The reality is quality metrics are being reported in a public forum today and have a significant impact on whether patients elect to have surgery at a particular hospital. In our world today there are many Internet review sites such as Angie’s List, Health Grades, and Zagat filled with patient reviews based on perception, not reality backed by data. Wouldn’t it be better to get in front of your quality data and use the information to make improvements that will help make a positive impact on patient care and satisfaction?

As I wrote in Part 1 of this three-part primer on quality reporting, the key is to establish a culture of quality where care providers aren’t threatened by the data. The goal isn’t to single out an individual provider but to use objective data to determine the root cause and establish new processes for improvement.

If quality reporting makes you conjure up images of jumping into shark-infested waters, read on to gain an understanding of the types of data typically reported, the variety of methods used for quality reporting, and the benefits. After all, knowing is half the battle.

Types of Data

Every patient encounter generates data as an output of the documentation process. The information you collect is used for billing for the facility and provider, to create the legal medical record for the patient, and finally as data that can be measured or benchmarked across a wide spectrum of areas.  

The data collected today is already used to measure items such as PQRS and SCIP that are process-based, such as whether a prophylactic antibiotic was administered within one hour prior to incision or whether temperatures were recorded at the right time in managing hypothermia. Such data is easy to record through charting and, when using an anesthesia information management system, easy to collect for reporting purposes.

However, future quality reporting requirements are expected to focus on performance measures based on outcomes that the patient cares about, such as if the patient acquired an infection that hampered his or her recovery and why the infection occurred. As reporting requirements get more complex, the need for easy access to data is intensified.

Reporting Methods

At January’s Practice Management conference, Richard P. Dutton, MD, executive director of the Anesthesia Quality Institute (AQI), discussed reporting methods ranging from “perfectly private” to “really, really public” in his presentation, “Quality Management, Data Collection and Reporting.” Each hospital and anesthesia group must decide which reporting method works for them and their cultures. Here is a brief description of each method:

• “Perfectly private” – Reporting of data between you and one other person
• “Private, with private benchmarks” – Self-reflection reporting that enables one care provider to see his or her data compared to a group in private so he or she is able to detect outliers and make adjustments to be in line with the group
• “Public, aggregate” – Aggregate reporting, such as trends in patient temperature in PACU, that is shared publicly with other care providers by posting in a common space such as the physician lounge
• “Public, within the family” – Care provider-specific reporting that shows names and is shared publicly with other care providers by posting in a common space such as the physician lounge
• “Public, within the institution” – Aggregate reporting that is shared publicly within the institution to provide transparency outside of the care provider family
• “Really, really public” – Proactive participation in external quality reporting organizations such as Consumer Reports

Benefits of a Quality Reporting Program

Stated simply, we cannot improve what we do not know. Establishing a quality program and reporting metrics provide the foundation for benchmarking that can help you make improvements and demonstrate value to your facility and the public.

In addition to reporting within your facility, I highly recommend participating in the Anesthesia Quality Institute (AQI). By submitting your quality data to AQI, your group or hospital will be able to use the reports you receive in return to help make improvements that can affect patient care and help you meet various regulatory requirements.

Let’s face it: regulatory requirements aren’t going away or getting any simpler and we must work to have the data to help us meet these and future requirements. But the real value in participating in quality reporting is the ability to drive change that can improve patient outcomes and experience.  

Eric Nilsson leads development and product management as Chief Technology Officer of Surgical Information Systems (SIS). He previously served as vice president of product management at Infor, where he was responsible for leading product management for the company’s SCM, CRM, CPM and EAM solution areas within Infor’s Strategic Solutions Group. Eric grew Infor’s SCM Solutions into a supply chain software provider across multiple industries with multiple software platforms. He is well versed in open systems (solution-to-solution) integration, product life-cycle management and user interface modernization. Prior to Infor, Eric served in several key management positions overseeing product management, engineering, quality assurance and documentation.

Is the Future of Interoperability Here Today?

I’ve often heard healthcare IT professionals reference the “hospital of the future.”

You know what I mean.  The hospital of tomorrow.  The utopian world where every bit of clinical information is captured in electronic bytes instead of manually scribbled on a paper chart (or worse, the back of a wrapper) with the hope that the information might make its way to the next care provider down the line – not to mention the permanent record - in a legible state. 

So, what does the hospital of the future look like?   The way I see it: 

• Computer systems and medical devices seamlessly communicate data, because they are designed to exchange data instead of operating in individual silos and as closed systems. 
• Information is delivered to the right people, in the right place, at the right time – making communication between providers, patients and families simple.
• And administrators, business managers, and care providers throughout the care continuum can actually get to the data they need – instead of sifting through useless reports -- to help them deliver safer care, more efficiently use their resources, and reduce their costs so they can continue to open their doors to their local community for yet another day.

It’s exactly the world they envision for their facility…someday.  Some people think that all they need is a single platform to deliver the hospital of the future to their organization. Yet even with a “single platform,” a hospital’s IT team will still have to integrate over 50 systems with a typical platform system.       

The hospital of the future.  While it may have been known by that moniker when it began a few years ago, the reality of a fully-interoperable healthcare facility - and all of the benefits that come with it – has never been more evident than at the Intelligent Hospital Pavilion at the HIMSS 2013 conference last month. 

An impressive display of devices and systems from over 50 vendors in six critical, data-rich areas of a typical hospital, the 13,000 square foot exhibit showcased how interoperable technology in the ER, Operating Room, ICU, Step-down Unit, Pharmacy, and Data Center can directly help the healthcare industry improve care quality and cost-effectiveness, efficiency, and communication. 

• Imagine capturing real-time patient data at the bedside and have it automatically fuel the hospital’s EMR for availability at every level of care across the enterprise.
• Imagine automatically displaying the current status of every OR in the surgery suite on your OR Director’s iPad, or sending audible updates to providers via a hands-free communication badge that’s worn like a necklace.
• Imagine a business manager aggregating three months (or years!) worth of data and getting materials cost comparisons by service line, specialty, and physician in just a few clicks. 

It’s not so difficult to visualize the scene or the benefits; but digging in and actually creating this kind of environment is another story.  Or is it?  Here’s what we heard from attendees at HIMSS:

It’s complex.  Even with just 50 different technologies on display, figuring out how to make them interact is actually the easy part.  To get the benefits, you have a plethora of decisions to make:

• What information do people, at different points in the care continuum, need and how do they want to receive it?
• Which technology “owns” a particular piece of data…where is the source of truth?
• With which systems will the information be shared?  Too much data moving everywhere is a recipe for disaster.
• Does data need to travel in one direction or two?
• What kind of security restrictions should be considered?
• How will we store data in a way that makes it easy for us to access it later on?

And the list goes on.  Interoperability may seem harder than people think, but looking to a single platform to solve that problem leaves a hospital without the latest efficient, cost-effective, innovated solutions their enterprise needs the most.  Real innovation comes from vendors who work together with healthcare leaders to connect information technology systems and devices based on a well-thought-out strategy.  With this kind of collaboration, some really amazing things can happen. Some examples?

• Radio Frequency Identification (RFID) capabilities that track materials and even the location of providers and patients. 
• Telehealth robots that zoom to the ER on command and interact with caregivers – and patients. 
• Anesthesia care information documented via touchscreen right in the OR. 
• The manager’s iPad dashboard displaying when that OR will be free for the next surgery. 
• The monitor in the waiting room that securely signals a family that their loved one has been moved to recovery. 
• That same anesthesia data being analyzed to pinpoint clinical metrics that can help drive improvement in terms of outcomes, cost, and satisfaction. 
• The capture and use of more information than we thought could possibly be created during a care event. 

What makes Intelligent Hospital visitors want to jump into this new world?  It’s the idea that technology can help us make healthcare safer, more efficient, less expensive, and easier on patients and their families.  Visitors got a first-hand glimpse of the benefits delivered by market-leading, highly interoperable solutions at the Intelligent Hospital.  Tracking materials helps manage inventory and costs, while tracking locations can reduce delays, improving patient satisfaction.  Telehealth robots provide access to clinical experts that may not be available in remote areas or other situations.  Accessible information fosters comprehensive communication with the care team, drives notifications and visual cues to help ensure care delivery meets safety and regulatory requirements, and enables us to analyze our performance so we know what we’re doing wrong, and right.

As CIOs, informatics leaders, IT project managers, and other HIMSS attendees left the exhibit, watching a new remote-presence robot interact with other visitors at the exit, it was clear that they were no longer daydreaming about the hospital of the future.

Instead, they were confident that the future of interoperability is today, and figuring out how to jump in with both feet. 

What’s your next step? 

Eric Nilsson leads development and product management as Chief Technology Officer of Surgical Information Systems (SIS). He previously served as vice president of product management at Infor, where he was responsible for leading product management for the company’s SCM, CRM, CPM and EAM solution areas within Infor’s Strategic Solutions Group. Eric grew Infor’s SCM Solutions into a supply chain software provider across multiple industries with multiple software platforms. He is well versed in open systems (solution-to-solution) integration, product life-cycle management and user interface modernization. Prior to Infor, Eric served in several key management positions overseeing product management, engineering, quality assurance and documentation.

News for the Perioperative Professional: 3/29/2013

First Do No Harm – Researchers Find Patient-Centered Care at End of Life Results in Happier Patients who Live Longer in Less Pain

Coordinated Care in the OR: Tips to Help Improve Throughput, Patient Safety

Coordinated care is a must-have in the OR, a complex, multi-risk, time compressed environment. It requires a well-designed schedule, accurate and comprehensive documentation, and enhanced, integrated communication between care team members.

So how can you create coordinated care in this complex space?

A Well-Designed Schedule
Building a well-designed schedule is the first step to optimizing the clinical, operational and financial performance of a hospital’s perioperative service – which is inherently more complex than other areas of the hospital. In the perioperative suite, you have issues - such as block scheduling and case shuffling - that do not normally occur anywhere else in the hospital. 

Prevent delays and help to ensure on-time case starts with timely, complete pre-admission testing (PAT). It can greatly affect costs – in fact, in “Redesigning the Pre-Admission Process for Impact” presented at this year’s AORN Congress, Renae N. Battié, MN, RN, CNOR stated that a cancelled case cost her hospital on average $5500. But accuracy and efficiency is not only imperative to support the financial health of the hospital, it also plays a part in the overall patient experience. Shifting cases and cancelling surgeries due to incomplete PAT information can negatively affect patient and family overall satisfaction. Integrated PAT and surgery scheduling using rules-based processes enable nurses and other care givers to streamline and more effectively perform the appropriate PAT in a timely manner, reducing the number of surgical cancellations and delays due to incomplete testing. 

Coordination Tip: Ensure your PAT scheduling process is closely integrated with your surgical scheduling process.

Additionally, access to perioperative analytics and historical case information can work in tandem with scheduling systems to provide schedulers a better idea of how long a certain surgeon may require to complete the case. If one surgeon generally takes two hours to complete a certain case, but his colleague takes two and a half, scheduling both of those surgeons in two hour blocks would certainly create delays for the second surgeon’s cases. Conversely, scheduling in two and a half hour blocks would not fully utilize room time. In scheduling, if you underestimate or overestimate case times, it can significantly impact throughput, resource, and facility utilization. This is often referred to as prediction bias. Prediction bias indicates whether the estimate of case times is consistently too high or too low. Efficient OR suites should aim for bias in case-duration estimates of less than 15 minutes per 8 hours of OR time.¹

Coordination Tip: Use case history to more accurately predict case times and maximize throughput.

Accurate, Comprehensive Documentation
Accurate, comprehensive documentation helps the right information get to the right clinicians at the right time. This leads to efficiency and supports patient safety initiatives. It is also a requirement for multiple compliance entities (e.g. The Joint Commission and CMS) and provides information necessary for programs such as SCIP, NSQIP, and AQI.  Documentation of outcomes (such as the percentage of hypothermic patients), surgical site preparation protocols, appropriate antibiotic administration, and medication reconciliation must all be tracked. The level and sheer volume of required data can no longer be supported with manual paper and standard reporting processes.

Perioperative checklists and workflow utilities can be used to help ensure pertinent information is captured.  A recent study from the New England Journal of Medicine found that teams using checklists were 74 percent less likely to miss key life-saving steps during emergency situations.

Coordination Tip: Use checklists and workflow process in your documentation system to help achieve compliance with mandated quality measures.

Integrated Communication between Care Team Members
The Joint Commission defines a sentinel event as “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.” According to their study Root Causes of Sentinel Events, 1995-2005, the leading cause of sentinel events in hospitals is attributed to poor communication. Communication failure has been identified as a leading source of adverse events in surgery.² In fact, the OR accounts for over half of all medical errors that occur in the hospital – many of which are founded in communication problems. More than one-third of communication failures resulted in visible effects on system processes, including inefficiency, tension among team members, wasted resources, surgical delays, patient inconvenience, and errors in procedure.³ Extensive research indicates that clear and accurate communication in the OR is a critical variable for improving patient outcomes and supports key National Patient Safety Goals by improving perioperative staff communication. 

Ineffective hand-off communication is widely recognized as a critical patient safety problem in health care. The Joint Commission Center for Transforming Healthcare estimates 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off. The “hand-off” process involves “senders,” the caregivers transmitting patient information and releasing the care of that patient to the next clinician, and “receivers,” the caregivers who accept the patient information and care of that patient.

Handoff protocols are critical in improving communication during handoffs. Situation, Background, Assessment, Recommendation (SBAR) is one technique that is widely used, but any series of processes will work as long as it is standardized for all involved and adequate training is considered an integral part of the program.

Coordination Tip: Develop and standardize handoff communication protocols , including your electronic documentation tools, to assist all care team members in having the necessary patient information for each phase of care.

How do you create coordinated care in your OR? 

With more than 35 years of nursing experience and the majority of those in the perioperative arena, Marion McCall, BBA, RN, CNOR, CPHIMS, is recognized nationally for her knowledge and expertise in the perioperative field with a focus on nursing informatics and health care information technology. She currently serves as a member of the AORN PNDS taskforce and is the Chairperson for the AORN Perioperative Nursing Informatics Specialty Assembly group. In the changing arena of electronic health records she serves as a clinical mentor to those implementing and struggling with the move to perioperative electronic health records. Marion currently serves as Vice President, Clinical Solutions Group for Surgical Information Systems.

¹Dexter F, Macario A, Epstein RH, Ledolter J. Validity and usefulness of a method to monitor surgical services' average bias in scheduled case durations. Can J Anesth. 2005;52:935-939

²The Joint Commission. Universal protocol for preventing wrong site, wrong procedure, wrong person surgery. http://www.jointcommission.org/PatientSafety/UniversalProtocol. [Context Link]

³Lingard L, Espin S, Whyte S, et al. Communication failures in the OR: an observational classification of recurrent types and effects. Qual Saf Health Care. 2004;13:330-334.

HIMSS Recap: How Intelligent Integration Can Drive Financial Results

As I joined over 34,000 of my healthcare peers recently in New Orleans for the annual HIMSS conference, I was energized by the enthusiasm, innovation and passion that those who choose to work in healthcare IT bring to this meeting. 

Over 1,500 companies - mine included - exhibited their solutions on the show floor.  But in addition to the exhibits and a great line up of keynote speakers and educational sessions, HIMSS went even further to help attendees visualize health IT in action. 

The Intelligent Hospital Pavilion at HIMSS was a must-see destination where visitors walked through clinical scenarios and saw firsthand the future of true intelligent device integration.  Following a patient through arrival by ambulance into the ER and then into the OR, the Intelligent Hospital displayed how the patient, the staff, the physical room and everything in it, are connected and sharing data. Sponsored by the RFID in Healthcare Consortium, the Intelligent Hospital was a living lab of what is to come.  

Providers are looking to implement real solutions that streamline operations and enhance patient care, all while decreasing costs.  The vendor community coming together to share data in ways that meaningfully support the care process and the care providers is what it’s all about.

Equally exciting was that all that connected data was also visualized in a central War Room/Data Center, giving us insights into how hospitals of the future will monitor and improve operations.

As we all know, patients in hospitals today are among the sickest we have seen and cost-effectively managing the increasing in-patient acuity levels is a key concern and challenge for our hospitals.  In fact, the American College of Healthcare Executives (ACHE) recently published the results of its annual CEO survey.  For the ninth consecutive year, financial challenges top the list of hospital CEO concerns with the top five challenges being:

• Medicaid reimbursement
• Government funding cuts
• Medicare reimbursement
• Bad debt
• Decreasing inpatient volume

While none of this data surprises any of us, it is easy to get disheartened, which is why meetings like HIMSS are a great way to re-focus the industry and remind us that we all play a big role in helping to deliver cost-effective, high quality care.  The Intelligent Hospital was a great endeavor that unleashed our collective creativity and demonstrated what our industry is and can do to help achieve these goals.  Healthy competition envisioned and implemented together with hospitals leads to better solutions for the hospitals we serve.

Our nation’s Operating Rooms sit at the center of the future connected hospital.  From the myriad of devices collecting data to the perioperative EHR that functions as the central hub for documenting the perioperative episode to sharing this rich data set with various stakeholders for actionable information, specialized perioperative IT helps hospitals deliver big results.  With surgical procedures representing up to 60% of a hospital’s margin and up to 40% of their expense, sustainable improvements deliver significant benefit. 

As we move to outcomes-based payment models, this focus increases.  Seventy percent of a hospital’s Value Based Purchasing (VBP) performance score ties to process of care quality measures.  A majority of quality measures originate in surgical services, including 10 SCIP measures pertaining to infection reduction and venous thromboembolytic (VTE) prophylaxis.  It is easy to see how failing to document SCIP measures on just one or two cases a week can result in negative scores that lead to lost reimbursement.  Supportive perioperative systems can help prevent that.

Forward-thinking hospitals are recognizing the importance and value of a perioperative-specific IT infrastructure that can give them a competitive advantage in meeting the challenges of delivering healthcare today and tomorrow.  We simply can’t improve the financial health of hospitals without focusing on the OR. 

 

Ed Daihl has dedicated the past 20 years to successfully building software and technology services companies, and turning them into world-class solution providers. Ed currently serves as CEO of Surgical Information Systems (SIS), a leader in perioperative IT. Ed has also served as executive vice president of revenue management and pricing with Manugistics, a leading provider of enterprise revenue management, pricing and supply chain software solutions. Before Manugistics, Mr. Daihl was president of CAPS Logistics, a provider of network design, routing and optimization software solutions and he also served as a management board member for Baan Corp.