denis o'leary - ballarat base hospital - how data has been used to optimise the surgical...
DESCRIPTION
Denis O'Leary delivered the presentation at the 2014 Operating Theatre Management Conference. Focusing on strategies for implementing the National Safety and Quality Health Service Standards and the importance of communication to improve patient safety and clinical practice, the 2014 Operating Theatre Management Conference brought together operating room management and perioperative professionals to review current initiatives across the country. For more information about the event, please visit: http://bit.ly/optheatremgmt14TRANSCRIPT
Knowing
how we
are doing
Well
Organised
Theatre
Scheduling
Team
Working
Booking Preadmission
The
Perfect
Pathway
The Perfect Surgical Pathway - Framework
Changing Culture Creating Certainty
Sustainability
Knowing
how we
are
doing Well
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
Pathway
Together we can do It
“Changing Culture Creating Certainty” Sustainability
The Perfect Surgical Pathway - Framework
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
ListKnowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
ListKnowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List Spread
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Surgical Patient Pathway
GP
GP Stage
Elective
Elective Surgical Patient Model of Care
Elective Stream
A Few Frustrations
• Lost paperwork • Variation in information • Access issues • Patients frustrations
GP
GP Stage
Elective
Elective Surgical Patient Model of Care
Elective Stream
Standard Referral Forms
GP Specialist
Preadmission
Outpatient
OPD Stage GP
Stage
Elective
Elective Surgical Patient Model of Care
Elective Stream
GP Specialist
Preadmission
Outpatient
OPD Stage GP
Stage
Elective
Elective Surgical Patient Model of Care
Elective Stream
Each individual Health Service and sites within Health Services have in place different systems, processes and paper work associated with the implementation of the Elective Surgery Access Policy
Open Access Endoscopy Cat 1 –Outpatients Cat 2/3 - Outpatients Private Patients from Rooms Urology Process Request for referral Health Questionnaire Consent Inconsistent policies
Variation
Standardised Practices
Frustrations • Lost paperwork • Health questionnaires not matched up • Private patients different process • Endoscopy open access different
process • Patients frustrations
This form can range anywhere from 1 to 16 pages depending on the Health Service
Paper Work a Surgical Patient Gets
Pack or diary is to be handed to each patient prior to placement onto the Waiting List. The information pack will be made available for consultant rooms along with the booklet containing the request for referral, consent and health questionnaire
Up to 40% of elective patients who are given a date for surgery have their date
changed
GP Specialist
Preadmission
Outpatient
OPD Stage GP
Stage
Elective
Adm Ward
Elective Surgical Patient Model of Care
Elective Stream
GP Specialist
Preadmission
Outpatient
Surgical Stage OPD Stage GP
Stage
Elective
Adm Ward
Elective Sessions
Elective Surgical Patient Model of Care
Elective Stream
GP Specialist
Preadmission
Outpatient
Surgical Stage OPD Stage GP
Stage
Elective
Adm Ward
Elective Sessions
Elective Surgical Patient Model of Care
Elective Stream
On the Day Cancellations can range anywhere from 1 – 16%
Week
GP Specialist
Preadmission
Outpatient
Surgical Stage OPD Stage GP
Stage
Elective
Emergency
Emergency Dept.
Triage Decision to Admit
Adm Ward
Elective Sessions
Elective Surgical Patient Model of Care
Elective Stream
Emerg Stream
GP Specialist
Preadmission
Outpatient
Surgical Stage OPD Stage GP
Stage
Elective
Emergency
Emergency Dept.
Triage Decision to Admit
Adm Ward
Ward
Elective Sessions
Elective Surgical Patient Model of Care
Elective Stream
Emerg Stream
Hip Fracture
GP Specialist
Preadmission
Outpatient
Surgical Stage OPD Stage GP
Stage
Elective
Emergency
Emergency Dept.
Triage Decision to Admit
Adm Ward
Ward Surgical Stage
Elective Sessions
Elective & Emergency Sessions
Elective Surgical Patient Model of Care
Elective Stream
Emerg Stream Elective & Emergency Streams Merge
Merged Streams
Unit of Activity
Contact Hours = Anaesthesia Start Time - Surgery End Time
One contact hour equivalent to one WIES
Data Knowing
how we
are
doingWell
Organised
Theatre
Scheduling
Team
Working
Booking
Preadmission
The
Perfect
List
Knowing
how we
are
doing
Knowing
how we
are
doingWell
Organised
Theatre
Well
Organised
Theatre
SchedulingScheduling
Team
Working
Team
Working
BookingBooking
Preadmission
The
Perfect
List
Weekly Contact Hours - Jan - 09 - May - 10
50.00
100.00
150.00
200.00
250.00
300.00
350.00
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Specialty (All) Surgery Day (All) Theatre (All) Op. Month (All) Hour Surgery Start (All)
Sum of Contact Hours
WeekNote the increase in the contact hours – 12 week moving average would indicate that this is not a one off
Contact Hours per week – Monday to Friday excluding Cardiology & Radiology
SpecialityAllocated Hours -
44 Weeks
Contact Hours
used within
Normal Hours
% Allocated
Contact Hours
used
Elective OtherEmergency within
Allocated Hours
% Elective in
allocated contact
hours
% Emergency done
within contact
hours
Emergency
outside Normal
Hours - Weekdays
Emergency
Weekends
Gen Surg 2,530 2,162 85.5% 1,582 180 400 63% 18.5% 453 302
Orthopaedics 1,914 1,919 100.3% 1,349 36 534 70% 27.8% 429 597
Obs& Gynae 1,562 1,508 96.5% 1,308 47 153 84% 10.1% 400 224
Plastics 1,408 1,178 83.7% 909 35 234 65% 19.9% 226 406
Vascular 1,232 1,102 89.4% 992 20 90 81% 8.2% 106 91
Urology 1,188 1,008 84.8% 986 11 11 83% 1.1% 66 19
Gastro/C.Rectal 1,452 860 59.2% 219 509 132 15% 15.3%ENT 308 231 74.9% 222 1 8 72% 3.5% 14 2
Miscellaneous 1,056 550 52.1% 516 7 27 49% 4.9% 96 80
12,650 10,518 83.1% 8,083 846 1,589 64% 15.1% 1,790 1,721
Actual Contact Hours -within allocated Elective Hours
Allocated Hours
Contact Hr Used Elective & Emergency
Contact Hr Used
Emergency in or out of hours
Speciality
Cancellation Wating List High/Low Increasing Beds
Speciality Elective Emergency BlankWL Cancellation
Rate on DOS
<500
>500 WL Inc/Dec Elective Emergency Other Total Beds
Gen Surg 2,259 2,214 166 15% 358 -200 13.8 15.3 1.3 30.3Orthopaedics 1,460 2,399 71 15% 607 150 8.2 18.0 0.3 26.5
Obs& Gynae 1,263 932 56 5% 179 -100 5.9 6.7 0.3 12.9
Plastics 940 1,242 56 1% 214 295 -20 2.1 2.2 0.1 4.4
Vascular 1,018 726 39 15% 310 13 50 6.7 6.6 0.3 13.6
Urology 1,002 149 10 19% 489 22 -50 3.4 1.8 0.0 5.2
Gastro/C.Rectal 379 837 497 1,159 1.6 9.9 11.1 22.6
ENT 220 180 1 7% 203 0 0.8 0.6 1.4
Miscellaneous 479 440 109 44 1.9 2.9 0.1 4.9
9,020 9,119 1,005 44.2 64.0 13.5 121.7
Actual WIES
Waiting List
Beds
Cancellations WIES
Speciality
Elective Elective Stream
Emergency Stream Stream
Proposed Elective Surgical Patient Model of Care
Aim: To clearly separate the Preoperative Elective & Emergency patients stream
GP Specialist
Preadmission
Outpatient
Surgical Stage OPD Stage GP
Stage
Emergency Dept.
Triage Decision to Admit
Adm Ward
Emer Beds
Surgical Stage
Elective Sessions
Emergency Sessions • Obstetrics • General Surgery • Orthopaedic • Emergency
Elective Elective Stream
Emergency Stream Stream
Proposed Elective Surgical Patient Model of Care
Aim: To clearly separate the Preoperative Elective & Emergency patients stream
The Need for Change Reporting Period: 1/9/2012 – 30/9/2012
Same process undertaken at another Health
Service
The Result of Change
Reporting Period: 1/10/2012 – 31/10/2012
GP Specialist Outpatient
Preadmission
Specialist
Outpatient
Surgical Stage OPD Stage GP
Stage
Emergency Dept.
Triage Decision to Admit
Adm Ward
8 Emer Beds
Surgical Stage
Home
Post Op. Ward
Post Op. Ward
Outpatient
Specialist
Elective Sessions
Emergency Sessions • Obstetrics • General Surgery • Orthopaedic • Emergency
Elective Elective Stream Elective & Emergency Streams Merge
Elective & Emergency Streams Merge Emergency Stream
Stream
Proposed Elective Surgical Patient Model of Care
Aim: To clearly separate the Preoperative Elective & Emergency patients stream
OPD Stage
OPD Stage
Theatre Contact Hour
Examples of How Contact Hours Might be Used
Need to consider the context relating to the Health Service
Normal Working Hours – Monday - Friday Metro
Need to consider the context relating to the Health Service
The data for this site would indicate there is capacity to do
additional procedural work within hours
Normal Working Hours – Monday - Friday Rural
Contact Hour by Day – Time Period – Year 12 -13
Useful to look at how much work is being done Out-of-hours and balance in terms of AM and PM hours
When investigated a “start on time” issue
was determined
Lists under booked
Surgeon Performance This type of data can be made available annual performance review meetings
Surgeon Data Broken Down Start Time
Theatre Contact Hours per Day by Operating Room
Can be used to determine how many contact hours will be made available when employing a full time anaesthetist
Anaesthetist Contact Hours
Theatre Contact Hours per Week – look for minimal variance
Ideally work undertaken after 17:00 should be less
than 10%
Contact Hours can be used on a Weekly Basis to Monitor projected Activity
Contact Hours can be used on a Weekly Basis to Monitor projected Activity
Contact Hour • Year, Month, Week, Day & Time of Day • per session • Capacity per Theatre • Funded Capacity • Income per Contact Hour • per Anaesthetist • per Surgeon
By using contact hour you can describe the business you are in and bridge the gap in understanding between front line clinicians and administrators
Relationship to WIES & Theatre Contact Hour
When a patient is discharged a Diagnostic Related Group (DRG) is allocated to that admission. For each DRG there is WIES allocation. So for each surgical admission there is a record of the Contact Hour associated with the surgical procedure(s) and the WIES generated during that admission.
WIES Payment 13 – 14 - $4,411
Benchmarking WIES per Contact Hour
WIES Payment 13 – 14 - $4,411
Activity Cost for Surgery
Stream
GP
Stream
GP Stage
GP Specialist
Preadmission
Outpatient
OPD Stage GP
Stage
GP Specialist
Waiting List/Booking Outpatient
Preadmission
Admission Procedure
In Patient Post Procedure
Care
Outpatient
Stream
Surgical Stage OPD Stage GP
Stage
GP Specialist Outpatient
Waiting List/Booking Outpatient
Preadmission
Admission Procedure
In Patient Post Procedure
Care
Specialist
Outpatient
Stream
OPD Stage Surgical Stage OPD Stage GP
Stage
GP Specialist Outpatient
Waiting List/Booking Outpatient
Preadmission
Admission Procedure
In Patient Post Procedure
Care
Specialist
Outpatient
Stream
Medicare
OPD Stage Surgical Stage OPD Stage GP
Stage
GP Specialist Outpatient
Waiting List/Booking Outpatient
Preadmission
Admission Procedure
In Patient Post Procedure
Care
Specialist
Outpatient
Stream Outpatient Payment Medicare
OPD Stage Surgical Stage OPD Stage GP
Stage
GP Specialist Outpatient
Waiting List/Booking Outpatient
Preadmission
Admission Procedure
In Patient Post Procedure
Care
Specialist
Outpatient
Stream WIES
Payment Outpatient Payment Medicare
OPD Stage Surgical Stage OPD Stage GP
Stage
GP Specialist Outpatient
Waiting List/Booking Outpatient
Preadmission
Admission Procedure
In Patient Post Procedure
Care
Specialist
Outpatient
Stream WIES
Payment Outpatient Payment
Outpatient Payment Medicare
OPD Stage Surgical Stage OPD Stage GP
Stage
Waiting List/Booking Outpatient
Admission Procedure
In Patient Post Procedure
Care
Stream WIES
Payment
Productivity is the ratio of output to inputs in production; it is an average measure of the efficiency of production. Efficiency of production means production’s capability to create incomes which is measured by the formula real output value minus real input value.
Contact Hour
Productivity
Surgical Stage
Waiting List/Booking Outpatient
Admission Procedure
In Patient Post Procedure
Care
Stream WIES
Payment
Productivity is the ratio of output to inputs in production; it is an average measure of the efficiency of production. Efficiency of production means production’s capability to create incomes which is measured by the formula real output value minus real input value.
Contact Hour
Productivity WIES = Contact Hour
Surgical Stage
Waiting List/Booking Outpatient
Admission Procedure
In Patient Post Procedure
Care
Stream WIES
Payment
Productivity is the ratio of output to inputs in production; it is an average measure of the efficiency of production. Efficiency of production means production’s capability to create incomes which is measured by the formula real output value minus real input value.
Contact Hour
Productivity WIES = Contact Hour Payment = Cost
Surgical Stage COST
Waiting List/Booking Outpatient
Admission Procedure
In Patient Post Procedure
Care
Stream WIES
Payment
Productivity is the ratio of output to inputs in production; it is an average measure of the efficiency of production. Efficiency of production means production’s capability to create incomes which is measured by the formula real output value minus real input value.
Contact Hour
Productivity WIES = Contact Hour Payment = Cost
Payment = Contact Hour
Surgical Stage COST
How do we Calculate
Surgical Stage Cost?
Waiting List/Booking Outpatient
Admission Procedure
In Patient Post Procedure
Care
Stream Contact Hour
Surgical Stage COST
Waiting List/Booking Outpatient
Admission Procedure
In Patient Post Procedure
Care
Stream Contact Hour
Cost Components
Surgical Stage COST
Nursing Salaries Medical Salaries Consultants Salaries Registrar Salaries Intern Salaries Theatre Technicians Consultant Anaesthetist Theatre Technicians Porters Patient Service Assistants Cleaners
Consumables Prostheses Superannuation Leave Workcover Pathology Radiology Printing CSSD
Example of Costs
Cost expenditure aggregated into cost centres based on Craft Groups & Location – in those
Centres - costs split into Salaries – Non Salaries
General Ledger
All the Cost Centres associated
with Surgical Stage 12 – 13
Wards
Not all of these Costs can be directly attributable to the
Surgery Stream – for example Sessional Surgery – 25% of costs
should be attributed to Outpatients
Determining Cost per Hour for Surgical Stage
Raw Extract of Cost Centre & Accounts relating to the Surgical Stream
See next few Slides for Derived Fields
Activity Where and by whom the Costs have occurred
Activity
Wards
Theatre Cost per Hour = Actual Cost
Theatre Hours
Example: Cost per Hour
$53,315,750
11,014
= $4,840
12,087
11,014
= 1.097
$53,315,740
$45,212,470
= 1.179
Need to factor in overhead(s) WIES Payment 13 – 14 - $4,411
Cost ($$$)
Activity (Contact hrs.)
Income (WIES)
