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Using Fileman to Obtain More Accurate Times for Surgeries by Surgeon Kevin McGuire, RN, BSN, CAC Karen Putnam, RN, MPH, OR Manager Background Karen Putnam, RN, BSN, MPA Eighteen years experience in the Operating Room Nine years as OR Manager Kevin McGuire, RN, BSN, CAC

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using fileman to obtain more accurate times for surgeries by surgeon

Using Fileman to Obtain More Accurate Times for Surgeries by Surgeon

Kevin McGuire, RN, BSN, CAC

Karen Putnam, RN, MPH, OR Manager

background
Background
  • Karen Putnam, RN, BSN, MPA

Eighteen years experience in the Operating Room

Nine years as OR Manager

  • Kevin McGuire, RN, BSN, CAC

Eighteen years experience Operating Room

Two months CAC

Began April 2003 with the VA Mather OR

some history
Some History
  • 2003 - Many Reports were still being manually generated by using paper printouts.
more history
More History
  • Led me to inquire about database tools I knew must be available.
  • Search led me to Fileman and Stephen G. Hill

who got me access and good start.

  • Once we got a glimpse of the power of Fileman,

all those remotely involved with Scheduling agreed some sort of Report Averaging the Room Times required for a Surgery by a given Surgeon was a worthy project.

goal of the operating room schedule
Goal of the Operating Room Schedule

To efficiently use the time allotted for scheduled surgeries by NOT:

Under-Utilizing

-or-

Over-Utilizing

OR time Available.

under utilization
Under-utilization
  • Refers to an Operating Room that remains empty though it is cleaned, equipmentally functional and is sufficiently staffed.

1) Leads to excessive backlog of Veterans

needing elective

surgeries.

2) Increased potential for

Idle Paid Staff.

over utilization
Over-Utilization
  • One or more Procedures going over their scheduled time.
    • Leads to delays for cases

to follow.

    • Opens the possibility for

cancellation of a scheduled

elective surgery.

(i.e. Patient does not want to wait, After hour staffing issues – how many Call Teams)

reasons for surgeries going overtime
Reasons for Surgeries going Overtime
  • The unexpected – cannot plan for.
reasons for surgeries going overtime9
Reasons for Surgeries going Overtime

Whadda Ya mean We only have time for an Appendectomy?

more reasons for overtime surgeries
More Reasons for Overtime Surgeries
  • “Bump” by Urgent/Emergent case
list of delay causes in fileman
List of Delay Causes in Fileman

Surgery File # 130, Field # 42 (Qty 26)

  • Choose from:
  • ANESTHESIA PROCEDURE DELAY
  • ANESTHETIST NOT PRESENT
  • BED AVAILABILITY
  • BLOOD LATE
  • Bed Availability
  • CONTAMINATION OF FIELD
  • HEMOTOLOGY REPORT LATE
  • ICU BED NOT AVAILABLE
  • IMED CONSENT
  • INCOMPLETE CHART
  • INSTRUMENT NURSE NOT PRESENT
  • INSTRUMENTS NOT READY
  • OPERATING SURGEON NOT PRESENT
more delay causes fileman
More Delay causes - Fileman
  • OTHER
  • PATIENT ACTION
  • PERMIT NOT READY
  • PRE-OP CARE NOT COMPLETED
  • PREVIOUS CASE DELAYED
  • SPECIAL EQUIPMENT NOT READY
  • STAFF SURGEON NOT PRESENT
  • SURGICAL NURSE NOT PRESENT
  • SURGICAL PROCEDURE DELAY
  • TRANSPORTATION DELAY
  • WARD DELAY
  • X-RAY PERSONNEL UNAVAILABLE
  • X-RAY REPORT LATE
more reasons for overtime surgeries13
More Reasons for Overtime Surgeries

The unappreciated

Can plan for but frequently gets missed.

  • Difficult IV start
  • Difficult Intubation
  • Atypical positioning/setup
more reasons for overtime surgeries14
More Reasons for Overtime Surgeries
  • Inaccurate time needed for Surgery

provided by Surgical Service

…Focus of this Presentation

surgery times provide by surgical service
Surgery Times Provide by Surgical Service
  • Subjective Data

- Influenced by a Genuine Desireto help as

many of their patients as possible.

(i.e. “Let’s squeeze them in here, between

the mega and the super mega.”)

  • Objective Data Needed

- Inanimate history based tool needed to

remove “emotional” factor.

fileman to the rescue
Fileman to the Rescue
  • A sort order of data by:

1) Surgeon 2) CPT Code 3) Date of Surgery

- Grouped Surgeries by Surgeon first

- Within each Surgeons’ Grouping, the surgeries

were grouped by CPT Code.

- The Date parameter

limited the data to a specific date range.

fileman sort
Fileman Sort
  • OUTPUT FROM WHAT FILE: SURGERY//
  • SORT BY: NUMBER// .14 SURGEON
  • START WITH SURGEON: FIRST// A
  • GO TO SURGEON: LAST// Z
  • WITHIN SURGEON, SORT BY: 27 PLANNED PRIN PROCEDURE CODE
  • START WITH PLANNED PRIN PROCEDURE CODE : FIRST//
  • WITHIN PLANNED PRIN PROCEDURE CODE , SORT BY: .205 TIME PAT IN OR
  • START WITH TIME PAT IN OR: FIRST// 110103 (NOV 01, 2003)
  • GO TO TIME PAT IN OR: LAST// 103105 (OCT 31, 2005)
fileman export fields
Fileman Export Fields
  • FIRST EXPORT FIELD: SURGEON//
  • THEN EXPORT FIELD: PLANNED PRIN PROCEDURE CODE //
  • THEN EXPORT FIELD: PRINCIPAL PROCEDURE//
  • THEN EXPORT FIELD: MINUTES(#11,#10)//
  • THEN EXPORT FIELD: PATIENT IN OR TIME//
  • THEN EXPORT FIELD: OPERATION TIME//

PATIENT IN OR TIME is the field used in the final Report to determine the amount of time to schedule the Surgery. It is the actual Time in Room in Minutes.

before and after
Before and After

Minutes

492885

517670

463835

413355

12.1%

5.03%

other fields to evaluate effectiveness
Other Fields to Evaluate Effectiveness
  • Field # 18 in the Surgery File (Qty 56)
  • Cancel Reason
  • Choose from:
  • ADMINISTRATIVE CANCELLATION
  • ALREADY DONE
  • ANESTHESIA
  • BLOOD NOT AVAILABLE
  • CHANGE IN ORDER OF CASES
  • CONSULT NOT DONE
  • DEATH
  • DOCTOR ILL
  • DOCTOR'S ORDERS
  • DOCTOR'S SCHEDULE
  • DUPLICATION
  • EMERGENCY CASE SUPERSEDES
  • EQUIPMENT PROBLEM
cancel reasons continued
Cancel Reasons Continued…
  • ICU BED
  • INCONVENIENT DATE FOR PT
  • INTRAOP CHANGE/MEDICAL STATUS
  • LAB TEST
  • MEDICAL
  • MISSED SHUTTLE
  • MRI,XRAY OR CT NOT DONE
  • NO CONSENT
  • NO LONGER NEEDED
  • NO ONE WITH PATIENT
  • NO PRE OP DONE
  • NO TRANSPORTATION
  • NURSING TEAM
  • OPERATING ROOM
cancel reasons continued26
Cancel Reasons Continued…
  • PATIENT CHANGES MIND
  • PATIENT ILL
  • PATIENT LATE
  • PATIENT MOVED
  • PATIENT NO-SHOW
  • PATIENT NOT NPO
  • PATIENT WOULDN'T GIVE REASON
  • PATIENT'S BEHAVIOR
  • PATIENT'S JOB
  • PATIENT/GUARDIAN REFUSES
  • PERSONAL EMERGENCY-PATIENT
  • PERSONAL PROBLEMS -PATIENT
  • PHYSICIAN NOT CREDENTIALLED
  • PRE-OP NOT DONE
and more cancel reasons
And More Cancel Reasons
  • PREV. CASE LENGTH
  • PT CONFUSED
  • PT DIDN'T FOLLOW INSTRUCTIONS
  • PT DIDN'T SAY
  • PT PASSED AWAY
  • PT PREFERS ANOTHER TIME
  • PT STATES UNAWARE
  • RESCHEDULED TO LATER DATE
  • SCHEDULING ERROR
  • SURGEON
  • TRANSFERRED CARE TO ANOTHER VA
  • UNABLE TO REACH PATIENT
  • UNKNOWN
  • WEATHER CONDITIONS
  • X-RAY
final note resources
Final Note & Resources
  • Final Note:

Be aware that there are people “Out there” that have Inside knowledge of how their department functions, who also have computer application skills that make them useful resources.

  • Resources:

Fileman - http://www.va.gov/vdl/application.asp?appid=5

http://www.hardhats.org/fileman/FMmain.html