SIP 5Measuring & Managing OR

Capacity/Utilization

Peter Buckley, MDLisa Brandenburg, COO

July 5, 2005

UWMC Surgical Block

Surgical Block Staffed minutes with RN/CST/CRNA/Anesthesia.

Allocated to Surgical Departments

Department accountable for management of their block

Surgeon accountable to accurately schedule elective cases into block time/ case load to be site appropriate/stay within block, not run over.

Block is time specific, not OR specific.

Subject to some rules- release, closure, etc

Full Block

“Open” Block

“Surgeon Specific” Block

“Partial” Block

Block Perspectives

Main Operating Room Block

Block RoomTime Rooms 1 2 3 4 5 6 7 8 9 10 11 12 13 14 20

13 7:45 7:45 7:45 7:45 7:45 7:45 7:45 7:45 7:45 7:45 7:45 7:45 7:45Gyn Oto Urol Gen Oto Ortho Ortho Surg Surg Surg TX Neuro Gen

13:30 Surg "C" "C" "C" \ SurgGyn Cardia Thor SurgC

13 Thor13

BYRD

13 7

74 : : :

U/E U/E U/E

: : :4 : : :3 : : :

U/E U/E U/E

: : :3 : : :1 :

:

:7:00

NoteU/E Indicates site available for urgent/ emergent cases

MONDAY

UWMC - Surgical ServicesMain - Block Operating Schedule

Effective July 8, 2005

15:30

17:30

19:30

23:30

21:30

Pavilion Block

Block RoomTime Rooms 71 72 73 74 75 76 77 78 79 80 81

6 285 Minutes 7:30 7:30 7:45 7:30 7:30 7:30 7:30 7:30 7:30 7:30 7:30+ 2 Annex Oral Urol Oto Close Close Urol Ortho Neuro Neuro Ophth Close

Robot

6+ 2 Annex

6 285 Minutes Gen+ 2 Annex Surg

6+ 2 Annex

12 Annex

MONDAY

UWMC - Surgical Services Pavilion - Block Operating Schedule

Effective July 8, 2005

12:15

17:00

19:00

Historical Block Distribution Block apportioned based on historical utilization

of OR (1996)

Block distributed on Surgical Department basis, not surgeon (1996)

Surgical Departments allocate times/block to individual Surgeons

Block time is specific, not OR specific (1999)

Block is Surgical Department specific, not surgeon specific

Block Utilization Formula

Total Dept. Block minutes used +national TOTotal Dept. Block Allocated- release time**

** Block release=dept. relinquish time 5 days before surgical day.

Albany Medical Center 1 week – full credit

Wake Forest University* 30 days – full credit

Abott NW Hospital 2 weeks – full credit

Parkland Hospital Not answered

*UHC Best Performance

Surgical Pavilion with Block Release, May

OTO GYN NEURO OPHTH ORAL ORTHO UROL GenSurg SurgT Total

Utilization % 77.2 77.1 66.3 77.3 77.9 71.6 71.6 76.4 17.1 72.6

Total Block Time 6,840 12,540 18,210 15,075 14,520 51,450 41,805 32,430 2,040 227,340

Release Time 570 570 2,100 2,100 2,790 1,140 3,090 7,905 1,530 29,700

% of Blk Released 7.7% 4.3% 10.3% 12.2% 16.1% 2.2% 6.9% 19.6% 42.9% 11.6%

Blk Min Used 5,282 9,671 12,075 11,656 11,304 36,827 29,926 24,772 348 165,016

Non Blk Min Used 1,474 1,388 512 3,081 3,350 3,150 1,189 2,132 98 18,448

Total Min Used 1,3 6,756 11,059 12,587 14,737 14,654 39,977 31,115 26,904 446 183,464

% of NBM 21.8 12.6 4.1 20.9 22.9 7.9 3.8 7.9 22.0 10.1

UWMC Surgical ServicesUtilization Summary By Service - Pavilion (Rooms 71 - 81, non-Annex)

March 2005 thru May 2005 (3 Months)

77.2 77.1

66.3

77.3 77.971.6 71.6

76.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0% of Utilization

Oto Gyn Neuro Ophthal Oral Ortho Urology GenSurg

Min w/ 20

Surgical Pavilion with No Block Release, May

OTO GYN NEURO OPHTH ORAL ORTHO UROL GenSurg Total

Utilization % 71.5 73.9 60.9 67.9 66.4 69.5 66.6 60.7 64.5Total Block Time 7,410 13,110 20,310 17,175 17,310 52,590 44,895 40,335 257,040Blk Min Used 5,297 9,686 12,371 11,656 11,486 36,573 29,895 24,482 165,739Non Blk Min Used 1,474 1,388 512 3,081 2,489 2,182 943 1,988 16,111Total Min Used 1,3 6,771 11,074 12,883 14,737 13,975 38,755 30,838 26,470 180,784% of NBM 21.8 12.5 4.0 20.9 17.8 5.6 3.1 7.5 8.9

UWMC Surgical ServicesUtilization Summary By Service - Pavilion (Rooms 71 - 81, non-Annex)

March 2005 thru May 2005 (3 Months)

71.5 73.9

60.9

67.9 66.469.5

66.6

60.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

% of Utilization

Oto Gyn Neuro Ophthal Oral Ortho Urology GenSurg

Min w/ 20

Reallocation of Block 2002 3 month rolling avg. including release >70%

1999 3 month rolling avg. including release >70% % block release Attempted every 3 months UHC comparisons

Block Utilization – Phone Survey of UHC Hospitals

Target Actual

Albany Medical Center 75% 75%

Wake Forest University 80% 70-79%

Abott NW Hospital Not Answered

Literature Review:

Johns Hopkins* 85%

Northwestern 80-85%

Established Surgeon

Professor Surgery Profile

0

100

200

300

400

500

600

700

800

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Year

New Surgeon Start up

Assistant Professor Surgery Profile

0

50

100

150

200

250

300

350

1996 1997 1998 1999 2000 2001 2002 2003

Year

Porter

Kadel

Mulligan

Flum

Mann

Oelschlager

Maronian

New Surgeon Start-up

New Surgeon- Rise in Surgical Case Load(Year 3 & 4 average cases as baseline)

0102030405060708090

100110120130140

0 1 2 3 4 5 6 7

Quarters

Per

cen

tag

e o

f ca

ses

Best: 72%Avg: 44%

Best: 92%Avg: 61%

Best: 91%Avg: 66%

Best: 118%Avg: 74%

Best: 103%Avg: 82%

Best: 132%Avg: 97%

  CHANGES IN SURGICAL UTILIZATION

Total (%) IP(%) OP(%)

1994 9833 5557 (57%) 4276 (43%)

2004 14030 6846 (49%) 7184 (51%)

Mean annual change

2.7% 2% 6%

2005 (proj.) 14628 6984 (47.5%) 7644 (52.5%)

Annual Change 4.2% 2% 7.7%

Impact of Block Release on OR Utilization

w/release % release w/o release

Main 72% 9.6%67.7%

Pavilion 72.6% 11.6% 64.5%

R2 67.7% 15.4% 57.2%

Why Block Release

To account for expected and predictable surgeon absences 4 weeks vacation 4 weeks meetings Surgeon usable year 52-8=44 weeks (release

8/52=15.4%)

No current agreement and operational limitation of block release

What To Do About Block Release Is Block release used?

Elective scheduling before block closureTBA/Red-Urgent/Emergent cases

Change block release rulesPredictable absences known well in advance eg. 8-12 weeks“full credit” for advance release-?10 weeks out“Partial credit” ?6 weeks out Released block booked in entiretyStudy extent to which released block is used.Close down/do not staff unused proportion 4-6 weeks out

Other Ways to Measure Utilization

Billed Minutes/Staffed Minutes“Raw Surgical Time Utilization”

Cut To Closed Minutes/Staffed Minutes

Main: 71% 52%

Pavilion: 53% 36%

Roosevelt: 55% 37%

UHC Conclusions to Maximize Room Utilization Match room coverage to demand, particularly on

evenings Empower clinical services to manage their

schedules Do not routinely hold rooms specifically to handle

emergency cases Implement approaches to timely case starts that

focus on timely collection of pre-op information and patient logistics

Engineer an efficient turn-around process Implement daily performance management and

reporting

Health Care Advisory Board Conclusions to Maximize OR Efficiency

Improve turn-around time Ensure on-time starts Rationalizing Pre-operative Testing Optimize Block scheduling Achieve same number of hours of elective

surgery daily

Dollar Value to UWMC of Changes in Utilization (in Contribution Margin)

5% Increase in Utilization at all Sites: $3M 5% Decrease in Turnover Time: $415K 20% Decrease in Turnover Time: $1.7M

Discussion Questions What are we trying to optimize for? What best practices should we adopt? How do we look at surgeon efficiency?