CVMC continues to be a destination OR for our community. But as we have grown both in technology and utilization, we realized that maximizing use of the existing structure, while adopting best practice would allow the department to progress from “good to great.” In the summer of 2007, both the Surgical Services and Anesthesia departments engaged with H*Works to improve processes at our organization. A team was formed to implement best practices that allow our hospital to enhance surgical services efficiency, focusing primarily on scheduling, preoperative process, and on-time starts. Team members included direct care staff, clinical managers, physicians, support staff and administrative leaders.
The first goal of the Operating Room H*Works team was to establish a best practice utilization model focused on improved block scheduling to increase utilization during prime time hours. Major accomplishments of the team included:
- Designed and installed the Surgical Services Joint Governance Council (SSJGC), whose purpose is to lead initiatives related to patient safety, customer satisfaction, regulatory compliance, productivity based block utilization and allocation and surgical services productivity. Council has been meeting monthly since January 2008.
- Updated and received approval for the OR administrative Operating Room scheduling policy to meet best practice standards.
- Increased the block utilization threshold to 75%, and adjusted automatic block release times base on historical scheduling patterns
- Improved prime time utilization from 60% to 70%.
The second goal of the team was to improve chart preparation accuracy prior to the day of surgery by formalizing expectations for preoperative testing and documentation requirements. Major accomplishments for the team included:
- Implemented process for obtaining demographics within 24 hours of scheduling
- Established guidelines to clarify chart item submission requirements and timelines
- Created and implemented a preop testing algorithm to clarify and standardize anesthesia preop testing requirements for all patients, and high-risk anesthesia triggers to flag patients requiring a preop anesthesia evaluation
- Created a timeline for full rollout of the updated preop and chart completion process
The final goal of the team was to increase the standardization and accountability processes by adopting best practices to improve on-time starts for the first case of the day. Major accomplishments include:
- Created start time matrix and scripting, detailing activities and defined roles required for completion of each process step from patient arrival to incision
- Eliminated the holding area as an additional stop for the majority of Day Surgery patients
- Improved the patient experience through implementation of provider introduction in Day Surgery
- Improved communication between Circulator and Anesthesia, resulting in coordination of patient transport to OR and preoperative assessment