MetroHealth Medical Center in Cleveland |
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Slashing "Non-Operative" OR Time:
TRUMPF Puts Theory into Practice with Rewarding Results
 There's no question about it: While your facility's operating rooms represent a vital resource for patient care and revenue, they also represent the greatest potential for lost income and lost time. Delays ranging from unforeseen complications to inefficient processes have far-reaching implications. When time is lost in the OR the downside goes well beyond financial. Lost time translates into longer hours, delayed procedures, fatigued staff, frustrated patients and families—and can ultimately affect the quality of care your facility provides its patients.
While the objective is to increase efficiency the questions remain:
- How do you increase efficiency without creating a larger burden than your staff is already shouldering?
- How do you increase efficiency and make sure corners aren’t being cut when it comes to providing quality care?
This was the backdrop for a study conducted by TRUMPF Medical Systems and Twin Peaks, a Boston-based medical consulting firm. The study was carried out at the Critical Care Pavilion, the OR department of the MetroHealth Medical Center in Cleveland, OH, under the direction of surgeon in chief Mark Malangoni, MD, FACS.
Pilot program tests theory
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| MetroHealth staff receive training in efficient patient transport using the TRUMPF ORBIT PT. |
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The consulting team placed the entire OR organization on the test bench and systematically looked for potential areas of improvement. The preliminary conclusion: new efficiencies could help costly OR time to be better utilized. Furthermore, by focusing on "non-operative" time--defined as room turnover time plus anesthesia induction and emergence--improvements could be derived outside the realm of the actual surgical procedure. This would allow for improved efficiencies while maintaining a high level of quality care.
The next step, putting the preliminary conclusions to the test, involved a strategy to exploit technical options and to systemize processes. Two of the 17 ORs were reorganized as pilot rooms for the test. The balance of the ORs would serve as a control group. The only limit put in place in the pilot rooms concerned case duration. Eligible procedures were determined to be those that were 2 hours or less in duration. The sequence of shorter procedures provided the greatest incidences of non-operative time during the course of a given day. |
One aspect of reducing non-operative time involved the development of processes to reduce all non-surgical tasks in the OR and to minimize non-clinical interruptions. Before the day of surgery, patients are seen for a preoperative assessment to ensure they have had a history , physical and appropriate lab tests. Operative permits are scanned into the hospital’s computer system to avoid delays related to misplaced paperwork. Orders are placed for prophylactic antibiotics, anticoagulants and other medications so they are available when the patient arrives in the OR. The objective is to ensure all organizational questions are clarified and all patient data is collected prior to the patient arriving in the OR.
Technology allows parallel workflows
| Another significant aspect of the test called for many workflows to be put in parallel. At almost all US hospitals anesthesia induction, surgery and recovery occur consecutively—all in the OR. This means surgical teams and patients must endure delays and unnecessary waiting, as procedures are completed one by one. In the MetroHealth pilot program, induction, surgery and recovery occurred simultaneously for different cases, as opposed to being done consecutively. Using the TRUMPF ORBIT PT which provides “one nurse, one button, no lifting” patient transference, the patient is transferred from his or her hospital bed to a JUPITER surgical table top. The patient and surgical table top are moved by means of a manual trolley system to an anesthesia area where the patient is prepared for surgery. While nurses are preparing for the case the patient is wheeled into the OR. The table top is docked to the JUPITER column in a simple procedure that takes just moments. The patient is induced and surgery is able to begin. As soon as the bandage is applied, room cleanup begins. |
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| The ORBIT PT allows "one nurse, one button, no liffting" patient transference to reduce non-operative time and improve patient and staff safety. |
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The patient still on the JUPITER table top is moved from the OR for emergence. Simultaneously, the next patient has already been moved into induction and will be ready as soon as the OR is prepared.
Conclusions indicate significant promise
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| The JUPITER System Table is among the technologies TRUMPF is using to bring new efficiencies to MetroHealth |
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According to results confirmed by Dr. Malangoni, non-operative time was significantly less in the test rooms. Target non-operative times of 35 minutes were regularly achieved and the results demonstrate that a coordinated multidisciplinary process redesign can reduce non-operative time by 30%. In cases when non-operative times were not within the 35 minute target, process-related delays were identified as contributing factors in 70% of those cases. This indicates further improvements are likely as non-clinical processes are fine-tuned. “We embarked on this project to improve patient satisfaction, and we have been able to do a better job of getting patients in at the scheduled time,” Malangoni says. “It’s also been a surgeon satisfier because they are getting their cases done more quickly.” On the topic of maintaining the quality of care offered, Dr, Malangoni says, “We have continued to emphasize patient safety, and we have found we can continue to do that while reducing time.”
Since the conclusion of the pilot program the same processes and technologies are being rolled out for additional rooms at MetroHealth. Facilities interested in exploring the possibilities offered by these and other Quality Care Consulting℠ services can call
TRUMPF at 1-888-474-9359.
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