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Transcript of 1 Process Improvement Team Operating Room Scheduling Final Report Respectfully Submitted to the OR...
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Process Improvement TeamProcess Improvement Team
Operating RoomOperating RoomSchedulingScheduling
Final Report Respectfully Submitted to the OR Committee Final Report Respectfully Submitted to the OR Committee May 1, 2007May 1, 2007
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Team LeaderStephanie Ramirez
Participating Team MembersDr. Greg Reece Melina ScarboroughDr. V. Gottumukkala Lancelot JonesPatricia Gage Nancy ReinertSusan McConihay Keith ShookAnthony Hoang Irvin SerraCarla Willis Corliss DenmanShirley Morrison Melanie LoprestoStacy Swanson Garry BrydgesMark Winograd
Technical ConsultantJim Vinci, Holland and Davis, LLP
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GOAL:GOAL:
To increase efficiency and accuracy of the Operating Rooms through an
effective and “rules based” scheduling system.
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OR Committee reviews the Team’s recommended solutions and approve with an addendum if necessary.
Forward recommended solutions & final report to OR Executive Team for approval.
Charter the Implementation Planning Team (action for OR Executive Team).
Requests the following:Requests the following:
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Overview
Team representative of all stakeholders Conducted Root Cause Analysis Problems identified:
Communication Staffing Information Technology Cultural/Behavioral
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MAJOR FINDINGS:MAJOR FINDINGS:
1. Failure to take advantage of web-based technology & electronic enhancements.
2. Inadequate structure leading to inefficiency & lack of standardization in scheduling processes.
3. Unpredictability of over & under utilization of OR resources.
4. Inability to track patients thru scheduling process to point of medical clearance.
5. Challenges of complex & multi-team cases.
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MAJOR FINDINGS:MAJOR FINDINGS:
1.1. Failure to take advantage of web-based Failure to take advantage of web-based technology & electronic enhancements.technology & electronic enhancements.
Solution Solution
Implementation of web based & electronic processes are indicated throughout presentation.
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Inefficiencies in inconsistent processes Inefficiencies in inconsistent processes affect everyone.affect everyone.
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MAJOR FINDINGS:MAJOR FINDINGS:
1. Failure to take advantage of web-based technology & electronic enhancements.
2.2. Inadequate structure leading to Inadequate structure leading to inefficiency & lack of standardization in inefficiency & lack of standardization in scheduling processes.scheduling processes.
3. Unpredictability of over & under utilization of OR resources.
4. Inability to track patients thru scheduling process to point of medical clearance.
5. Challenges of complex & multi-team cases.
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MAJOR FINDING:MAJOR FINDING:
2.2. Inadequate structure leading to inefficiency Inadequate structure leading to inefficiency & lack of standardization in scheduling & lack of standardization in scheduling processes. processes.
Short-term Solution (3-6 months)Short-term Solution (3-6 months)
Use this ordered set of priorities to schedule cases:
Patient Safety Maximize OR efficiency Reduce patient waiting time Surgeon preference
Dexter et. al. Making Management Decisions on the Day of Surgery Based on Operating Room Efficiency and Patient Waiting Times, Dexter et. al. Anesthesiology 2004; 101-1444-53
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Short-term Solution (3-6 months)Short-term Solution (3-6 months)
Assign scheduled cases based on principles of efficiency:
Assign by historical case length. Assess OR resources and match
case length. Consider equipment restrictions when
assigning operating rooms. Arrange cases to maximize OR efficiency
(bin stacking) to optimize available resources (minimizing over utilization).
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Short-term Solution (3-6 months)Short-term Solution (3-6 months)
Ensure patient safety through adequate preparation for cases:
Finalize schedule by specific time (to be determined) before day of surgery.
Avoid posting simultaneous case starts in ACB & OR on a single day.
Avoid replacing cancelled cases with new cases in the 24 hrs prior to the day of surgery (excluding urgent/emergent).
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MAJOR FINDINGS:MAJOR FINDINGS:
1. Failure to take advantage of web-based technology & electronic enhancements.
2. Inadequate structure leading to inefficiency & lack of standardization in scheduling processes.
3.3. Unpredictability of over & under utilization Unpredictability of over & under utilization of OR resources.of OR resources.
4. Inability to track patients thru scheduling process to point of medical clearance.
5. Challenges of complex & multi-team cases.
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MAJOR FINDING:MAJOR FINDING:
3.3. Unpredictability of over & under utilization Unpredictability of over & under utilization of OR resources.of OR resources.
Short-term Solution (3-6 months)Short-term Solution (3-6 months)
Assign a scheduler to each Alkek quad & ACB to schedule cases/assign rooms using the nurse manager as a resource.
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Recommended Structure for Surgery Recommended Structure for Surgery SchedulingScheduling17
Scheduler reviews request in surgery scheduling queue
(w)
OR scheduler Nadine
RoboticsGynUrologyThoracicPediatrics
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Surgical Oncology
OR scheduler Michelle2
NeuroOrthoPain
OR scheduler Elena4
H & NOpthalmology / ENTDental OncologyPlastic Surgery
OR scheduler Paula1
ACB OR
OR scheduler Matt5
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Short-term Solutions (3-6 months)Short-term Solutions (3-6 months)
Assess allocation of time by services.
Assess opportunity to post cases with defined allocated time parameters.
Use historical data to: Estimate case duration for scheduling. Validate service allocation utilization &
duration with upper prediction bounds.
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Short-term Solutions (3-6 months)Short-term Solutions (3-6 months)
Identify a representative (Chair or designee) from each Service to assist with resolving conflicts in case scheduling.
Assess opportunity to identify coordinator in each Service to work with surgeon and PA to coordinate scheduling of cases.
Establish oversight process to review service allocation utilization quarterly.
Modify service allocations based on review findings.
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MAJOR FINDINGS:MAJOR FINDINGS:
1. Failure to take advantage of web-based technology & electronic enhancements.
2. Inadequate structure leading to inefficiency & lack of standardization in scheduling processes.
3. Unpredictability of over & under utilization of OR resources.
4.4. Inability to track patients thru scheduling Inability to track patients thru scheduling process to point of medical clearance.process to point of medical clearance.
5. Challenges of complex & multi-team cases.
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MAJOR FINDING:MAJOR FINDING:
4. Inability to track patients thru scheduling process to point of medical clearance.
Intermediate Solution (6-12 months)Intermediate Solution (6-12 months)
Enhance current IT systems to improve patient flow, communication, and patient preparation.
Collaborate with IT & PI to develop electronic and web-based systems (white board subprocess) with business rules for accurate tracking of patients and extraction of data
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MAJOR FINDINGS:MAJOR FINDINGS:
1. Failure to take advantage of web-based technology & electronic enhancements.
2. Inadequate structure leading to inefficiency & lack of standardization in scheduling processes.
3. Unpredictability of over & under utilization of OR resources.
4. Inability to track patients thru scheduling process to point of medical clearance.
5.5. Challenges of complex & multi-team cases.Challenges of complex & multi-team cases.
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MAJOR FINDINGS:MAJOR FINDINGS:
5.5. Challenges of complex & multi-team cases.Challenges of complex & multi-team cases.
Short/Intermediate Solution Short/Intermediate Solution (Timeline as indicated)(Timeline as indicated)
Develop a centralized “time away” calendar to improve process of scheduling multi-team cases. (3-6 months)(3-6 months)
Automate process to notify stakeholders and collect data regarding a change or cancellation of case. (6-12 months)(6-12 months)
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Recommended Implementation TeamRecommended Implementation Team
Greg Reece, MDProcess Improvement
Program Manager
TBDCommunication
Manager
RFO IPT
Project Manager
Stephanie RamirezScheduling IPT
Project Manager
Melina ScarboroughAssistant Program
Manager
TBDImplementation/Change
Agent Advisor
Recorder/Coordinator
Facilitator
Communications Specialist
OR Nursing
Scheduling
Surgeon
PA
PI
IT
Anesthesiologist
Process Improvement Program Task Force4/26/2007
CRNA
Director POE Operations
Surgery Scheduling Implementation Planning Team
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New Surgery ProcessNew Surgery Process
Note:
White Board subprocess is workingin parallel to scheduling process
Scheduling is notified that all is clear on White
board
Scheduling begins to finalize schedule
Are there still OR space available within
24-48 hours?
Review “add-on” queue- RULE
BASED
Go to next patient in queue
Is surgeon still available?
Are all other OR resources available?
Is the patient available?
AConfirm surgery with
all stakeholders
Are there still available slots?
YES
YES
NO
YES
YES
NO
Finalize Schedule
YES
NO
Schedule is closedNO
YES
NO
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NO
35
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32
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YES
NO
Patient Requires Surgery
Surgery Done
Nursing and Anesthesia will accommodate the patient at earliest slot
Is it urgent or emergent?
Is it an emergency?
YES
1 2 3
4
5
A
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Is this a Multi-disciplinary case?
Primary surgeon or designee reviews
availability calendar of all surgeons (w)
YES
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BWhite Board Subprocess
NO
B
Primary surgeon requests adjunct
surgeons on the case (w)
Tentatively block adjunct surgeon's
calendar(s)- rule based estimated length of
times (w)
Primary surgeon consult adjunct
surgeons on case (w)
Have consultations been scheduled or
done? NO
YES
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15
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Patient is examined by adjunct surgeon(s)
Adjunct surgeon determines type of procedure and
estimate length of procedure- Enters
information into system re: special needs
Surgeon’s availability adjusted on availability
calendar
15a 15b
Surgeons or designee requests schedule thru web
system (w)
Request goes into surgery scheduling
queue (w)
Surgeon’s review their availability (w)
NO
Schedulers reviews request in surgery
scheduling queue (w)Check OR availability
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10
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Is OR available? NO
Tentatively schedule case in OR Manager & notify requester that surgery is
scheduled pending clearances which must be completed 48 hours prior to surgery
Requesting surgeon or designee reviews check off list (Whiteboard) for
completeness of request (w)
Is request and clearance complete?
YES
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DNO
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C
YES
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Emergent/Urgent:•Patient Safety White Board:
Patient SafetySingle & Multidisciplinary Scheduling:
•Patient Safety•Maximize OR EfficiencyOR throughput
Scheduling queue to OR Manager: •Maximize OR efficiencyOR throughputPatient waiting time•Surgeon preference
Final Schedule & Add On Cases: •Patient safety•Maximize OR efficiency•Patient waiting time•Surgeon preference
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Comments, Suggestions, DiscussionComments, Suggestions, Discussion