Time for Tracking: Leaders at Greenville Hospital System Improve Efficiency and Effectiveness in the Perioperative Arena

Stainback: And there are about eight or 10 checklist items involved, and any outstanding items that needed to be completed in order to not impeded the progress of the patient through surgery, the system can alert us to that. For example, if the surgeon has not done an H&P update or a surgical site marking, the system will send them alerts, in the form of an e-mail or text message, or in whatever form they choose to be communicated with.

Ritchie: We’re currently using text messaging to notify anesthesiologists when the patient enters the OR suite and goes underneath that portal; the anesthesiologist can plan their next five to 10 minutes, to make sure they’re present in the operating room, for the induction of anesthesia, to prevent delays, since anesthesiologists typically manage the anesthesia for about four surgeries at once.

Have you been able to document any measures of improvement of time-efficiency in the OR?

Stainback: As you know, healthcare is very complex; and the perioperative environment, I would say, is one of the most complex; there are a lot of moving pieces. And to say that one project single-handedly made an improvement or detracted from it, is not easily done. But we certainly know that this particular tool has enhanced our performance in various ways. And we have various principles that we call pillars—a quality pillar, growth pillar, financial pillar, people pillar, etc.—and in terms of the people pillar, we know that there’s been enhanced staff satisfaction, because they now have an easier means of communication, and a fuller picture of what’s going on with the perioperative process. And some of the metrics they like to focus on are on-time case starts. We just had a consulting firm in, and they were giving us accolades for our performance in that area.

You know that you’ve had improvement in on-time case starts?

Yes.

And this was part of that change?

Stainback: Absolutely. And as we’ve been able to trend our patient satisfaction, it’s not that this product has single-handedly improved our patient satisfaction, but this product has obviously been a contributor. And we know that part of that is that we’ve acquired much fewer overhead pagers. And we do patient routing post-op with patients and families; and we’ve actually been pretty amazed at the feedback we’ve received from patients and families. And we have, for wont of a better term, “frequent flyers.” And even with the limited information we’ve been able to give them through this tracking tool, they’ve been very pleased. They can see on a continuous basis where their patient is, and they view that as a real enhancement.

On the quality side, by having information in a more granular fashion, one of the things we’ve been able to do—the perioperative environment is very emotionally charged, and there’s generally a steady stream of surgeons coming in to complain about something, and oftentimes, it’s not very factually based. The thing about ORMax is that it allows you to very factually sort through things. And the capture of that data not only helps dispel rumors and myths in their mind; it also gives us very granular data that we can use to make improvements in our perioperative processes. One of the areas related to quality is that there’s a Joint Commission focus, and actually a standard out there to implement better process flows.

We also think that this is a tool to help us with patient logjams; we don’t have logjams in periop as many hospitals do.

What core lessons have you learned that you’d like to share with CIOs and CMIOs?

Ritchie: I think what ORMax has been able to do has been to reduce the communication overhead between caregivers on status updates, and through automation, better connect the staff members to the full perioperative process, rather than just their own little work area, such as preop holding or PACU. Nurses can see how what they do can affect downstream or upstream processes.

Stainback: I would agree, and I think the ability to really proactively resolve issues, has been a real outcome of this. We tend to be very reactionary in healthcare, and not very proactive in solving problems. This allows you to create greater efficiency in perioperative flow. So we’ve continued to grow as an organization, and this tool has been one element in that growth. We have been able to grow concurrently with decreasing capacity. And it’s not ORMax that’s the only thing to contribute to this. But it has helped facilitate that, as a result of having a better system in place to monitor flow, per capacity.