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7oftheMostImportantMetricsforMeasuring
OREfficiency
WrittenbyRobKurtz|January19,2012
MichaelSimon,MD,NorthAmericanPartnersinAmericananesthesiologist,directorof
cardiothoracicanesthesiaatVassarBrothersMedicalCenter,chairmanofanesthesiaatUPMCHamot
MedicalCenterandpresidentelectoftheNewYorkStateSocietyofAnesthesiologistssays
improvingoperatingroomefficiencyisatthetopofthelistofprioritiesforallhospitalORs.

"TherearemultiplereasonsastowhyhospitalslooktoincreaseORefficiencies,whetheritisdueto
thepressuresfromsurgeons,governmentorpayors,"Dr.Simonsays."Withthatbeingsaid,hospitals
needmorethaneverforalloftheirstaffandserviceproviderstobealignedwiththeirgoalstoensure
andsustainsuccess.Asanesthesiologists,it'sjustamindsetthatwehavetoprovidequalitypatient
care,whileworkinginconjunctionwithotherimportantstakeholderstoformateamdedicatedto
constantimprovement."

ThereareafewcriticalelementstoachieveORefficiency,hesays.Firstandforemost,strong
perioperativeleadershipneedstobeputinplace.

"Whenyoudon'thaveanaccountable,pointpersonwhorunstheOR,managesscheduling,vacation
coverageandeffectivelycommunicateswiththesurgicalteam,thingsjustkindoffallapart,"hesays.
"Itisimperativethattheperioperativedirectorhasastrongunderstandingastohoweachfunction
withinthehospitalimpactstheotherfunctionsinteractingwiththeORinordertogetthemonthe
samepage.

"Thisinvolvesdevelopingasupportiveandresponsiveworkenvironmentthatpromotesapositive
workingrelationshipbetweenleadershipandthestaffmemberstoensurethatdailyactivitiesare
effectivelycarriedout,"Dr.Simoncontinues."Otherwise,withalackofcommunication,youhave
peoplerunningaroundindifferentdirections,allwithdifferentmotivatorsanddifferentmindsetswith
howthingsgetdone.Throughvariousexercisesinteamtrainingandkeepingeveryoneabreastof
whatthecommonthemeisyoureallyareabletomaximizeefficienciesthroughouttheday.

"Inadditiontotheplacementofaneffectiveperioperativeleader,trackingandmeasuringdataoneach
casewillhelptoproveresultsanddriveimprovementintheOR,"hesays.

Dr.SimonidentifiesthefollowingsevenmetricsassomethemostimportantformeasuringOR
efficiency:


1.Firstcasestarts.Thismetricmeasuresthestarttimeforthefirstcaseofthedayandshowshow
oftenafacilityactuallybringspatientsintotheORattheirscheduledtime.

"Althoughweallliketothinkwe'rereallygoodatthat,inessencewe'renot,"Dr.Simonsays."A
goodORthatrunsreallywellispleasedwhenitgetsthatnumberupto90percentorabove,which
comeswithmuchhardshipandpreparation.Thatjustdoesn'thappenbecausethenamesappearonthe
scheduleforafirstcasestart."

Toachieveahighsuccessrateforachievingontimefirstcasestarts,hesaysanorganizationmustbe
diligentaboutlookingatthereasonswhypatientsdonotarriveintheORatscheduledtimes.When
youcangettotheheartofthatmatterandfixtheproblemscausingthedelays,itwillmakeallofthe
hospital'scustomershappier.

"PatientsatisfactionwillincreaseduetothefactthatthepatientwillnowgointotheORwhenthey're
supposedto[and]surgeonsatisfactionwillincreaseasaresultoftheirpatientactuallybeingpresent
intheORwhentheyarriveforthecase,"Dr.Simonsays."Thisalsointurnmakesthehospitalhappy
asthisproducesthehugebenefitofminimizingwastedORtime,whichaffectstheoutcomesofother
metricssuchasturnovertime."

2.Turnovertimes.Therearemanyfactorsthatdriveturnovertime,alsoknownasthelengthoftime
betweenwheelsoutoftheORtowheelsin.Thiscanincludeaninefficientcentralprocessingof
instrumentsorcanbearesultofamultidisciplinaryprobleminvolvingnursing,anesthesia,
housekeepingandtheturnoverteamstaffnotworkinginsync.

Dr.Simonsaysmosthospitalswillhaveturnovertimessomewhereintheneighborhoodof2535
minutes,dependinguponthesizeofthecase.AreallyefficientORiswhenyoucanturntheroom
overinabout12minutesforamajorgeneralsurgerycase.Thisallgoesbacktohavinganeffective
perioperativeleadertoensurepatientflowismanaged,hesays.

3.Percentoflocationsusedandwhattimesaretheyused."It'sveryimportanttohaveahandleon
exactlyhowmanyanesthetizinglocationsareinafacility,"Dr.Simonsays."WhetherthosebeORs,
GIlabs,EPlabs,cathlabs,obstetrics,laborroomsallofthoseplacesneedtobetakeninto
considerationwhenyoutalkaboutanesthetizinglocations."

Afterdeterminingthenumberofanesthetizinglocationsinyourfacility,youshoulddeterminehow
oftenandatwhattimesthey'reused.Bytrackingthis,youcanmaximizeyourpersonnelandmove
peoplearoundstrategically,whichwillworkoutmuchmoreefficientlyasfarasstaffusage.

Forexample,ifyoulearnthroughtrackingyourdatathateveryTuesdayandThursdayyouusually
haveafewanesthesiaprovidersthatarenotneededinORsintheafternoon,youcanplantoprovide
anesthesiatolocationsoutsideoftheORduringthesetimes.

"ProceduralistswhoarenotintheORlovethatbecauseitprovidesthemwithregularityastowhen
anesthesiaisavailablefortheirservicessothattheycanscheduleaccordingly,"Dr.Simonsays."It
takesoutthatunknownelementforthem."

4.Complications.Dr.Simonsaysanorganizationshouldtrackuntowardeventsandcomplicating
factorsinordertodeterminewhichcomplicationsoccurfrequently,whytheyoccurregularlyand
developasolutiontocounteracttheseissues.

"Isitafaultofthesystem,isitafaultofthepeopleinvolved,isitsomethingbeyondyourcontrol,"he
says."Whenyouhavecomplicationsyoucanactuallydosomethingabout,thatonlyservestoenhance
thewholeprocess.Butyouhavetohaveahandleonthat.Soyouhavetohaveanaccuratemeansof
trackingthosecomplicationsandknowingwhatyouroutcomesactuallyare.Thatgoestotheheartof
whatagoodanesthesiagroupwilldoaspartoftheservicetheyprovide."

Dr.Simonalsonotesthatcomplicationscanbeforlessacuteissues,suchasmeetingcoreSCIP
measures."Wehavetohaveantibioticsinwithinanhour,wehavetohavepatientsbroughtoutata
certaintemperatureandwewillhavetodomoreandmoreofthose[requirements]everyyear,"Dr.
Simonsays."Youhavetohaveahandleonhowwellyoudothosethingsnotonlytoensureyou're
providingthehighestqualityofcaretothepatientbutalsototakeintoaccountthatifyoudon'tgive
patientstheirantibioticsontime,you'regoingtofindthatMedicarestartsdockingreimbursementto
thehospitalandeventuallytotheprovidersinaverymethodicalway"

5.Valuebasedpurchasing.Youalsowanttomakesurethatinworkingtoimproveefficiencies,you
alsotrackotherimportantelementsofasuccessfulOR'soperations.Onesuchelementisvaluebased
purchasingintheperioperativesettingandtheassociatedmetricsorganizationsmustnowmeet."You
needtomakesurethatallvaluebasedpurchasinggoalsarebeingmetasyoualsotrytotacklethese
othergoalsinimprovingefficiency,"saysSimon.

6.Consistencyofservice.Whilethisisnotametricperse,itisacomponentthatisveryimportantin
maximizingtheflowoftheOR.

"That'ssomethingsurgeonsalwaystalkabouttheywanttohaveaconsistencyofservicefromall
constituentsintheOR,"Dr.Simonsays."Nothingbothersasurgeonorproceduralistmorethan
havingdifferentprovidersgivedifferentlevelsofservice.Thatreallyendsupslowingdownaday,
slowingdownaproviderandit'sreally[wasted]resourceswhenyoudon'thaveaconsistentserviceat
alltimes."

7.Outcomes.Whenyoulookatoutcomes,youareabletodeterminehowwellyourprovidersdeliver
acertainserviceandmakethenecessaryadjustmentsforimprovement.Forexample,howwelldo
theypreventPONV?

"Ifyoutrackcomplicationsofalltypes,suchasnauseaandvomiting,youcanconcludewhycertain
providersbringpatientsoutwhotendtobemuchmorenauseousandneedtospendmuchmoretime
intherecoveryroom,"Dr.Simonsays."Perhapssomeprovidersliketousemorenarcoticsorsome
don'tliketouseantiemetics.Thisarmsyouforadiscussionwiththoseprovidersabouthowtheydo
thingsalittledifferentlyincomparisontotheircolleagueswithlowerratesinthatarea."

Bytrackingoutcomesbyprovider,youcangainabetterunderstandingoftheconsistencyofservice
andcanbringaboutchangeintheothermetricsyouaretrackingandworkingtoimprove.

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