Will improving operating room turnover time reduce Hospital costs due to delaye

SMAC Topic/Contract Checklist – HCM 641 – Health Care Finance and Reimbursement

Student Name: Alpha Omega Addo Owusu

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SMAC Description: Respecting the value of linking knowledge with experience to enhance learning, students pursuing a Graduate Management Studies degree or certificate will complete a project in each course, which applies and develops the functional area of management represented by the course to an appropriate issue/problem/task within an actual organizational environment.

The SMAC is an analysis and discussion of a Finance Strategic Plan (FSP) developed to reduce costs/expenditures within a health care institution. The Plan may also include as a goal increase efficiency which leads to reduced costs/expenditures. The Plan analysis must be related to work experience and must support an attempt to improve a managerial ability. A large capital project should not be used. You should take on the role as a project manager while researching and writing the SMAC.

If a Team SMAC List all students on the team:

Answer the Following Questions. (Your answers to these questions must be typed onto this side of the form)

Professor’s Comments

SMAC Question – Write your SMAC topic in the form of a question?

Will improving operating room turnover time reduce Elmhurst Hospital costs due to delayed cases, increase revenue and prevent doctors taking their case to different hospital.?

State whether the analysis being conducted is within an actual organizational environment? If not, how do you plan on satisfying this SMAC requirement?

Intervention to improve Elmhurst Hospital OR turnover time

1. I will use quantitative analysis to improve the surgical delay and improve financial lost to the hospital. There would be precondition insertion of any operative discipline in the analysis.

2. EVS, cleaning OR rooms turnover need to be improved from (1 hour to 30 minutes)

3. Central Sterile department needs to buy more instruments and complete all missing instruments in trays so that cases could be improved. For example, loaners should be received 48 hours before procedure date.

4. Surgeons, not starting cases in time need to improve their schedule. Anesthesiologist delay needs to be improved or more medical team must be recruited.

5. Specialty head nurses MUST periodically communicate with surgical team, case schedule team and all stakeholders to make sure patients are cleared for their procedures 24 hours prior to surgery date. etc.

6. One of the ways I would improve turnover time is to focus on real-time data collection without compromising patient care experience as a strategy in customer analytics. Thus, Head nurses would be equipped with tablets zoom access that will enable allow clinical team contact patients ahead of time for any cancelations and prep clients like two hours before surgery starts.

7. Through quantitative analysis hospital would be able to form target parameters for the OR management surgical team to reduce turnover time from one procedure to another. For example, improve transporting patient from their homes, floors to the OR ETC.

8. Improve informed consent process.

9. By the end of my SMAC I will strongly be committed to using quantitative analytics to reduce operating costs while increasing revenues.

Results

This analysis would study Elmhurst Hospital operating room surgical delays. I will use quantitative analysis to improve the surgical delay and improve financial lost to the hospital. There would be precondition insertion of any operative discipline in the analysis. EVS, Central Sterile department, surgeons, etc. Through quantitative analysis hospital would be able to form target parameters for the OR management surgical team to reduce turnover time from one procedure to another. By the end of my SMAC I will strongly be committed to using quantitative analytics to improve turnover time, operating costs while increasing revenues.

Indicate specifically how you will be able to provide information regarding funding and expenses related to the intervention?

1. This analysis would study Elmhurst Hospital operating room surgical delays. Talk to Specialty head nurses, Doctors, Peri-operative Director, Doctors,

2. I will visit budget office and get information from the HHC on how much the hospital looses in terms of surgical delay due to turnover time? (proposal to but more medical devices or instruments)

3. Perioperative director’s analytics team to collect large amounts of data from turnover in real-time.

4. I will talk to hospital administration to collect data on how the facility lost money when cases are delayed and when turnover time is improved how much was saved.

What financial information will you obtain to conduct a feasibility analysis?

1. Determine an average reimbursement per case? The SMAC would help me analysis and estimate if a surgeon became dissatisfied, began bringing his cases to another facility, and he did 10 cases a month; what would that cost the organization?

2. How much does it cost when a case is delayed for an hour?

3. What is a dollar amount when a case is canceled?

4. How much overtime would be paid from one case delay to the other in a day?

5. What is the Total cost of medical supply and instruments? (loaner trays, doctors preference trays) etc.

Learning Contract Instructions

Attach the approved Learning Contract with the Managerial Abilities Recap form to the SMAC.
Insert a page break at the end of your SMAC before inserting the Learning Contract.

Office of Graduate Management Studies

Self-Directed Managerial Applications Component

Proposal/Learning Contract

Attach the approved Proposal/Learning Contract to all SMACs

Attach the Abilities Recap form from MGT 500 to this form

Student(s): Alpha Omega Addo Owusu

Instructor: Professor Michael Burghardt

Course: HCM 641 – Health Care Finance and Reimbursement

Proposed title of project: Could improving the turnover time in between surgery, delay cases in the Operating Room reduce Hospital cost?

1. Issue/Problem/Task to be addressed:

1. My SMAC will measure how much the hospital lost in when the surgeons perform their surgeries at different facilities.

2. How much did it cost the hospital to employee extra EVS staff to help reduces turnover room time?

3. How much did patient’s dissatisfaction based on delays, cancelled cases and lawsuits cost the hospital.

2. Topic(s) from Functional Knowledge are Related to the Issue/Problem/Task:

Improved turnover time in the OR will go a long was to let patients have good surgery experience, Patient safety, increase hospital financial gains as well as market share and investment.

3. Anticipated Managerial Abilities to be Developed:

This analysis would study Elmhurst Hospital operating room surgical delays. I will use quantitative analysis to improve the surgical delay and improve financial lost to the hospital. There would be precondition insertion of any operative discipline in the analysis. EVS, Central Sterile department, surgeons, etc. Through quantitative analysis hospital would be able to form target parameters for the OR management surgical team to reduce turnover time from one procedure to another. By the end of my SMAC I will strongly be committed to using quantitative analytics to reduce operating costs while increasing revenues. One of the ways I can accomplish this is to focus on real-time data collection without compromising patient care experience as a strategy in customer analytics. Head nurses are now equipped with tablets that allow perioperative director’s analytics team to collect large amounts of data from turnover in real-time.

4. Proposed Project Design/Plan:

I will talk to hospital administration to collect data on how the facility lost money when cases are delayed and when turnover time is improved how much was saved. I will also use scholar peer review data.

5. Resources:

Digication eportfolio :: marivic paraz-lee, rn :: nurs 653 – internship: Clinical nurse leader. (2020). Internship: Clinical Nurse Leader.

American Association of Colleges of Nursing. (2013). http://www.aacn.nche.edu/cnl/CNLCompetencies-October-2013.pdf

Bhatt, A. S., Carlson, G. W., & Deckers, P. J. (2014, November 8). Improving operating room

turnover time: A systems-based approach. J Med Syst, 1-8. http://dx.doi.org/10.1007/s10916-014-0148-4

Cima, R. R., Brown, M. J., Hebl, J. R., Moore, R., Rogers, J. C., Kollengode, A., … Deschamps,

C. (2011). Use of lean and six sigma methodology to improve operating room efficiency

in a high-volume tertiary-care academic medical center. American College of Surgeons,

83-92. http://dx.doi.org/0.1016/j.jamcollsurg.2011.02.009

Gottschalk, M. B., Hinds, R. M., Muppavarapu, R. C., Brock, K., Sapienza, A., Paksima, N., …

Yang, S. S. (2016). Factors affecting hand surgeon operating room turnover time. HAND,

11, 489-494. http://dx.doi.org/10.1177/1558944715620795

Harders, M., Malangoni, M. A., Weight, S., & Sidhu, T. (2006). Improving operating room

efficiency through process redesign. Surgery, 140, 509-516. http://dx.doi.org/http://dx.doi.org/10.1016/j.surg.2006.06.018

6. Ethics and Social Responsibility:

Reducing OR turnover time is ethical and as medical team, socially keep patient safety.

It also medically prudent, ethical to make sure Patients, and family are satisfied when they come to receive healthcare.

By the end of the SMAC in would be able to apply ethical, be socially responsible and pay attention to patient flow. Finally make sure I use instruction for Use to reprocess Instrument and medical devices to reduce surgical acquired infection.

Individual Project
or Team Project
(Degree candidates are required to complete at least two SMACs as a team with other students from the course and at least two SMACs to be completed individually. Effective Spring 2016: Certificate candidates are required to complete one team SMAC and one individual SMAC).

Is it your intent to present this SMAC to your company? Yes
No

Student Signature(s):

I (we) agree to uphold the College’s core value of academic integrity. I (we) pledge that this SMAC will not contain one or more sections, in whole or part that have already been included in another SMAC without BOTH instructors’ explicit approvals. Any violation of this provision constitutes Academic Dishonesty.

 

If a Team Project: ____Approved # of Team Members

____Required # of Pages (excluding Abilities Section, References Page and Exhibits)

Instructor(s) Approval:______________________________

Reducing Operating Room Turnover Times

Data Source / Literature Review

At an ASC, the ORs are the income-generating areas of the facility but are also the most

costly resources. According to Gottschalk et al. (2016), OR TOT has been much the focus of attention and improvement because it allows the surgeons to maximize their caseload, which helps OR productivity. The literature compiled for this project supports the concept that improving OR TOT is cost-effective while improving OR efficiency and patient satisfaction. The following literature review demonstrates the various strategies that support this theory. In a study by Bhatt, Carlson, & Deckers (2014), the authors’ strategy was to initially identify any current problems that are affecting the TOT management and implement a redesigned process that would improve average TOT and reduce process variability. This study did not limit their redesign focus on the OR alone, but rather, utilized a system-based access. Three major interventions that were carried out were: developed an OR readiness criteria to be utilized consistently, implemented parallel processing to assist patient and OR readiness and improve communication amongst the perioperative units. Post-implementation of the redesigned process indicated a significant reduction in both the mean and standard TOT based on 237 subjects. Mean TOT was reduced by 0:20:48 min, a 46.9% reduction and standard deviation was reduced by 0:10:32 min, a 64.2% reduction. A study performed by Gottschalk et al. (2016) focused on the contributing factors that may affect hand surgeon OR TOT. Performed by five attending hand surgeons, a total of 685 hand cases was performed over a 15-month period. The authors speculated that some of the factors that influenced TOT were the following: the surgeon’s presence in the room, case type.

Case scheduled time and the patient’s American Society of Anesthesiologists (ASA) class.

Results indicated that TOT was shorter in cases where the surgeon remained in the OR during turnover (27.5 minutes vs. 30.4 minutes). Patients categorized under ASA Class 1 and Class 2 had significantly shorter TOT by 8.2 minutes and 9.9 minutes respectively than Class 3 patients. The scheduling of cases also had an impact on TOT and it was noted that TOT were longer when it took place between the hours of 12:00 noon and 1:00 pm. Surgical cases were performed in both an ASC and in an orthopedic specialty hospital (OSH) and results indicated that the cases performed in an ASC had shorter TOT (27.9 minutes vs. 36.4 minutes). This study presented different factors that can affect TOT but one limitation that needs to be noted is that the study is limited to orthopedic hand surgery. Kodali et al. (2014) decided to focus on the organizational challenges that can present during operational changes to workflow. The study was performed at Brigham and Women’s Hospital in Boston, a great academic medical center that has 793 beds with 43 functioning ORs. Two previous attempts to implement the process improvement of improving TOT has failed in the past and this prompted the authors to focus on what challenges and barriers are encountered and how to overcome them. Some of the barriers that were encountered were: staff resistance to change, failing to sustain new changes, geographical location of ORs and the lack of support to mobilize change from the physicians. Except for the geographical issue, the main theme noted was that OR leaders’ presence within the units, especially during the critical implementation phase was important since it conveyed monitoring and support to the staff. Despite of the barriers, the study resulted in an average decrease in TOT of 4-5 min in a 47- minute turnover, reflecting an 8-10% improvement. A study performed by Reznick, Niazov, Holizna, Keebler, & Siperstein (2016) centered on the utilization of a dedicated OR team to help improve OR TOT time. The OR team consisted of an OR nurse circulator and OR scrub tech that was oriented to the surgeries that the endocrine surgeon performed. This pilot program consisted of 25 cases

performed with the new dedicated team. They theorized that using a dedicated team will improve OR efficiency due to the familiarity of the procedures and less distraction. Overall, the program was successful in not only decreasing the overall OR time from 125.51 minutes to 112.1 but it also decreased the OR TOT from 29.0 minutes to 26.4 minutes, a 9.0% improvement. Performing a PICO search for the above-mentioned articles proved to be quite challenging when determining what combination of words to use to receive the type of articles that would be relevant to my project. After various attempts, the PICO search that provided me the results were: P – surgical patients, I – surgery in hospital, C surgery in an ambulatory surgery center, O – operating room turnover time.

Timeline

The projected timeline for this project encompasses a total of seven months for the startup in three phases. The initial phase includes the preliminary meeting with stakeholders involved, data gathering and project planning and training. This takes place between the months of December 2016 – March 2017. The second stage is the implementation of the project with concurrent testing utilizing the Model for Improvement with Plan-Do-Study-Act (PDSA) cycles. According to Nelson et al. (2007), the Model for Improvement serves as a structure to test ideas with anticipated improvements. The last phase is to re-assess and evaluate the initial results of the project for the quarter that it was implemented by the stakeholder’s biggest barrier faced in this project was during the implementation phase. The combination of the unexpected acquisition of the ASC by a larger institution and preparation for a state survey occurred during the month of March, which caused the implementation to be delayed until further notice by management.

Conclusion
Providing safe, high quality patient care with active patient participation resulting in positive patient outcome is our organization’s goal. This proposed project is aimed to improve OR efficiency by decreasing OR TOT resulting in both staff and patient satisfaction as well as cost effectiveness for the organization. Conducting the research and data gathering for this quality improvement project made me realize that even making slight changes such as appropriate scheduling of surgeries, reconfiguration of OR materials and equipment and appointing specific tasks to team members can greatly influence the length of waiting period for both patients and surgeons as well as saving thousands of dollars per year for the company. There were pros and cons as to conducting this type of project in an ASC. Introducing the CNL role to a small facility proved to be a challenge initially since the role was unchartered territory and staff members were having a hard time distinguishing whether my role was as a staff nurse or of a supervisory role. After clearly explaining to the staff that my purpose was to lead the team on this improvement project at the microsystem level and serving as a resource, many were in support of the project and were willing to contribute their assistance. Though it was slightly disappointing not being able to implement the project and seeing the outcome as planned, I remain confident that the project will serve its purpose once it’s implemented and will have a positive impact on the organization and the patients it serves. This project would not be possible without the full support of my professors, the staff at the ASC, my clinical nurse manager, and my preceptor. I am both humbled and honored having been presented the opportunity to learn from the best in both the academic and professional setting. Through this project, I have gained experience and knowledge that will greatly assist me in my future endeavors as a Clinical Nurse Leader to provide care in true Ignatian-Jesuit spirit cura personalis – to care of the person as a whole (Ignatian Spirituality website, 2009-2017).

References

Digication eportfolio :: marivic paraz-lee, rn :: nurs 653 – internship: Clinical nurse leader. (2020). Internship: Clinical Nurse Leader.

American Association of Colleges of Nursing. (2013). http://www.aacn.nche.edu/cnl/CNLCompetencies-October-2013.pdf

Bhatt, A. S., Carlson, G. W., & Deckers, P. J. (2014, November 8). Improving operating room

turnover time: A systems-based approach. J Med Syst, 1-8. http://dx.doi.org/10.1007/s10916-014-0148-4

Cima, R. R., Brown, M. J., Hebl, J. R., Moore, R., Rogers, J. C., Kollengode, A., … Deschamps,

C. (2011). Use of lean and six sigma methodology to improve operating room efficiency

in a high-volume tertiary-care academic medical center. American College of Surgeons,

83-92. http://dx.doi.org/0.1016/j.jamcollsurg.2011.02.009

Gottschalk, M. B., Hinds, R. M., Muppavarapu, R. C., Brock, K., Sapienza, A., Paksima, N., …

Yang, S. S. (2016). Factors affecting hand surgeon operating room turnover time. HAND,

11, 489-494. http://dx.doi.org/10.1177/1558944715620795

Harders, M., Malangoni, M. A., Weight, S., & Sidhu, T. (2006). Improving operating room

efficiency through process redesign. Surgery, 140, 509-516. http://dx.doi.org/http://dx.doi.org/10.1016/j.surg.2006.06.018

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