ISOC - Operating Room Task ForceEfficiency Comparison in OR
April 5, 2013, Hamburg
Ines Gurnhofer, Head of OR DepartmentMatthias Spielmann, MHA, CEO
Agenda
Short presentation of the project and the timeline
Feedback and problems with the evaluation / data quality
Comparison of the various resources with distinction in various orthopedic centers
Evaluation results
Common problems
Take Home Messages
ISOC Operating Room Task Force April 5, 2013 Hamburg2 │ 20.04.23
CV
Ines Gurnhofer
OR Management – Head of OR Departement Schulthess Clinic Zürich 2003-
Head of OR Departement Orthopaedic Hospital Speising Vienna 1996-2002
ICU Clinical Hospital Zagreb 1989-1995
University of Applied Sciences and Arts Luzern
MAS Management in social and health services 2005-2008
Vinzentinum Health Academy Vienna 1998-2008
Medical School Baden n. Vienna 1996-1997
Medical School Zagreb 1985-1989
OR- Management International Congresses: Vienna, Salzburg, Köln, Berlin, Zürich, Düsseldorf
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Task Force Operating Room – Efficiency Comparison
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OR management focuses on maximizing operational efficiency at the facility, i.e. to maximize the number of surgical cases that can be done on a given day while minimizing the required resources and related costs.
Operating room efficiency is a measure of how well time and resources are used for the intended purposes.
We have therefore opted to conduct an efficiency comparison using the operating process as a basis with three phases within the process:
Pre-operative process (induction phase) Delays and other problems
Intra-operative process (operating phase) Staff structure
Post-operative process (recovery phase) Nothing spezial
Task Force OR Project Timeline
April 2012 Kick-off Meeting with M. Spielmann, MHA, CEO, Project Leader
Mai 2012 Creating a questionnaire for our project
June 2012 Sending a questionnaire to ISOC- Clinics
July 2012 Deadline for answers
November 2012 – March 2013 Analysis - working on project results
Today ISOC- Meeting in Hamburg presentation
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Feedback and Problems with the Evaluation-Data Quality
– Failure to meet the deadlines
– Last questionnaires received in Nov. 2013
– From additional questionaires that we sent out in February 2013, only 60% return rate
– Various questions could not be answered because in some institutions various data points are not available
“Errors using inadequate data are much less than those using no data at all...”
Charles Babbage
1791-1871
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Number of Operating Rooms (per Institution)
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Number of Minutes allocated for Operations per Year
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Total Number of Orthopaedic Operations 2011 - 109`864
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Adjusted Utilisation
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Adjusted utilisation uses the total hours of elective cases performed within OR block time,including «credit» for the turnover times necessary to set up and clean up
Start- time Delay in Minutes
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Start – time Delay for Elective Cases per OR per Year
ISOC per day 168 min
ISOC per week 840 min ( 5 working days)
ISOC per year 42000 min ( based on operating 50 weeks per year )
McKinsey&Company
42000 min x 16€
672`000.00 € / 873`808 USD or «700 Operations» - 60 min HIP Prostheses
Delays in the operating room have a negative effect on its efficiency and the working environment
Delays can be attributed to human errors and system deficiencies and the surgical operating room is rife with both!
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Most Common Causes for Delays – Hospital Comments
Patient arrival at day of surgery
Transfer of the patient from ward to OR
Surgeon and anaesthesia late
Surgeons allocating too many procedures to a «300» min session
List order changes
Surgion defined wrong duration of surgery
Not enough induction area (parallel preparations of patients)
Long in- between cases changing time
Absence of anaesthetic preparation room
Preparation room for OR nurse – old building
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Delays in OR
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Lession to learn
Continuous documentation of all delays in OR
Detailed analysis of delays and classification by cause
Analysis of all operational processes
Process- knowledge check and training sessions if necessary
Intraoperative time management of surgeons needs to be improved
Permanent sensitization about “time loss” in OR and intraoperative inefficient time management
Decision-making competence: OR- Management Committee
OR- Statute accepted and signed by all Chief- Surgeons
CEO and hospital management must be involved to get higher decision competence
Trying to solve problems with infrastructure (sometimes impossible if hospitals are old)
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OR Statute
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Pre-operative Process (Induction Phase)
Preparing the patient for the operation
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Recommendations – Induction Phase
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A holding area for the preparation of the patient is very importantProcesses run faster with enough staff for patient positioning and parallel working
This affects preoperative delays and reduces themDelays in the start can be made up only with difficulties
Where the Induction takes placeCentral
induction areaInduction
areaOR
Campbell Clinic USA
Clinica Alemana Chile
Helios Endo Klinik Germany
Hospital for Special Surgery USA
Instituto National de Rehabilitaciòn Mexico
IRCCS Istituto Ortopedico Galeazzi Italy
Istituto Ortopedico Rizzoli Italy
Mater Hospital Australia
Royal National Orthopaedic Hospital UK
Schulthess Klinik Switzerland
Sint Maartens Kliniek Netherlands
Skàne University Hospital Sweden
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Situation with Anaesthetic Preparations
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Patient Positioning
Induction area OR
Campbell Clinic USA
Clinica Alemana Chile
Helios Endo Klinik Germany
Hospital for Special Surgery USA
Instituto National de Rehabilitaciòn Mexico
IRCCS Istituto Ortopedico Galeazzi Italy
Istituto Ortopedico Rizzoli Italy
Mater Hospital Australia
Royal National Orthopaedic Hospital UK
Schulthess Klinik Switzerland
Sint Maartens Kliniek Netherlands Spinal Local
Skàne University Hospital Sweden
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Staff Structure per Operation / CaseRN qualified staff Surgeons ,
AssistantsAnaesthesiology
Campbell Clinic USA 1 RN / 1 Surg. Ass. 1-3 1Anaesthesist / 1CRNA
Clinica Alemana Chile 1 RN / 1 Cert. Surg. Ass. 1-3 1Anaesthesist / 1Nurse
Helios Endo Klinik Germany 2 RN or OTA 1-3 1Anaesthesist / 1A. Nurse
Hospital for Special Surgery USA 1 RN / + Surg. Tec. 1-3 1Anaesthesist 1-2 OR /1Nurse Anaesthesist
Instituto National de Rehabilitaciòn Mexico
2 RN 1-4 1Anaesthesist
IRCCS Istituto Ortopedico Galeazzi Italy
1 RN / 1 Surg. Ass. 2 1Anesthesist 1-2 OR /1 Nurse Anesthesist
Istituto Ortopedico Rizzoli Italy 1RN/1 Surg. Ass./ 1 Cast. Nurse
3-4 1 Anaesthesist1 Nurse Anaesthesist
Mater Hospital Australia 1-2 RN 2 1 Anaesthesist
Royal National Orthopaedic Hospital UK
3 1-3 1 Consultant Anaesthesist
Schulthess Klinik Switzerland 2 RN or TOA 1-3 1 Anaesthesist 1 Nurse Aanesthesist
Sint Maartens Kliniek Netherlands 2 Surg. Tec. 1-2 1 Anaesthesist 1-2 OR1 Nurse Anaesthesist
Skàne University Hospital Sweden 1-2 RN 1-3 1 Anaesthesist 1-2 OR1 Nurse Anaesthesist
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Lession to learn
– Induction and patient positioning in OR reduce the efficient utilization of the operating room
– Patient positioning for orthopedic surgery is often complex, takes a long time and therefore may block valuable surgical capacities
– OR capacities must be maximized for surgical activities
– All supporting and accompanying processes need to be relocated away from limited OR space
– Otherwise any anesthetic complications may affect OR capacities
– Various int. OR projects and publications have shown that induction in the OR adversely affects the overall OR utilization
– OR Managers and Architects patronize for the future holding and central induction area
“only the flying aircrafts make money”
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Follow-up Project
Definition of parameters and time points for assessments
Monitoring and critical evaluation of all delays in OR
Analyze subspecialty-/ surgeon-specific allocation of OR capacity
Implement improvements based on previous assessments of OR efficacy
Then reevalute OR efficacy following these implementations
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Thanks for the attention!
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