As patient volumes continue to increase across healthcare organizations around the country, hospitals are seeing a greater need to become more resourceful throughout the entire system. One area where the New Brunswick, N.J.-based Robert Wood Johnson University Hospital (RWJUH) saw a need to enhance efficiency was in its operating rooms (ORs).
In 2012, Amy Smith, R.N., vice president of perioperative services at RWJUH, saw an opportunity to use actionable data to achieve impactful change, including optimized staff and resource use, reduced overtime, and lowered costs. “Through our perioperative services, we looked at areas of opportunity based on patient volume shifting, and we realized there were improvements to be made,” Smith says. “There was a need to get turnaround times down, the percentage of cases starting on time up, and we had to fit the increasing volume into our daily schedule.”
But like most hospitals, RWJUH was well aware of the market competition and the increased pressure to be efficient. “You don’t have two or three years to find a solution and give you the data that you need to make the changes,” says Smith. As a result, RWJUH tapped into analytics software from the hospital's core perioperative vendor, the Alpharetta, Ga.-based Surgical Information Systems (SIS). Smith is now tracking operating room turnaround times, on-time case starts, overtime and OR use. With this new information, Smith can discover where bottlenecks happen that can shrink operating room use, cutting into the biggest revenue drivers for hospitals.
Previously, data was getting exported and dumped into Microsoft Excel, a process that was messy, looks like spaghetti, and doesn’t align, says Smith. There was also data manipulation leading to skepticism because there was so much to do with it, she says. “It was so mom and pop before, and everything had to be explained. Once you went through that process and they understood that those variables were captured, it became much easier.” And when SIS presented RWJUH with analytics, it aligned with most of the performance indicators that the hospital wanted to monitor, says Smith. “Data extraction became so easy within the system with formulas that calculate turnaround time and start times. We tested the data’s validity because while people want the data, they might not always like what they receive,” she says.
Amy Smith, R.N.
With the new software, data is fed into the analytics dashboard from the SIS perioperative system. For each surgery, Smith knows how long it takes to prep the patient, when the first incision was made, actual time in surgery, and how long it takes to clean the room and prep it for the next patient. If cases don't start on time, Smith knows the reason. It could be that the paperwork was incomplete or the surgeon was late, or blood wasn't cross-matched before surgery, housekeeping wasn't available, or the surgeon didn't block enough time for the procedure.
And that type of transparency has led to a significant improvement in the hospital’s OR efficiency. Pre-analytics, an analysis of 1,300 procedures found that 500 cases ran over the expected time, and 40 percent started late. After the clinicians and staff leveraged the analytics to make process improvements, the number of cases that started on time has risen to 81 percent, and overtime savings totaled $500,000 in the last three quarters of the year, reducing the amount of OT by 47 percent. “We built in through the system how to get that data, and while that’s great data, it doesn’t fix a problem,” says Smith. “We were able to go to the next level by setting up a tracking mechanism within SIS to give me all the reasons our cases were running late. Was it a surgeon delay, instrument delay, anesthesia delay? Once we knew what it was, we could modify the system to create those dashboards to drive the improvements to get that on case start time up,” Smith says.
And the best part, continues Smith, is that the data is in real time. “Today, I can get a report of yesterday’s cases that started late that the staff may not have documented on—so we would follow up on that. It helped us change our culture,” she says. Previously, members of the OR staff would see this as another late case initiative or another turnover initiative—it was looked at as another flavor of the month, Smith says. “But we can look at the data every day and can put it in front of people, scrutinize it, and follow up. We have a manual dashboard with statistics updated weekly for everyone to see. This way, we are able to hold the staff accountable.”
The final piece to the puzzle was getting surgeons on board and engaged with the transparency of data, but that wasn’t really a challenge at all, says Stanley Trooskin, M.D., chief of surgery at RWJUH. “One of the hardest things is to get a meaningful discussion with the surgeons about the data,” he says. “But this is a very fluid healthcare environment, and as we move into an accountable care-based model, efficiency is one of the better ways to deal with that. The more efficient you can be, the more you conserve resources, and the better it will be for both parties.”
As such, continues Trooskin, hospitals and surgeons have to interact with a common goal. “The only way to do that is with data. So you need to show everyone why it’s in their best interest, which it is. Surgeons are highly educated professionals, so when you come at them with highly educated data, good things will happen.”