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ISOC - Operating Room Task Force Efficiency Comparison in OR April 5, 2013, Hamburg Ines Gurnhofer, Head of OR Department Matthias Spielmann, MHA, CEO. Agenda. Short presentation of the project and the timeline Feedback and problems with the evaluation / data quality

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Agenda

ISOC - Operating Room Task ForceEfficiency Comparison in ORApril 5, 2013, HamburgInes Gurnhofer, Head of OR DepartmentMatthias Spielmann, MHA, CEO


Agenda
Agenda

ISOC Operating Room Task Force April 5, 2013 Hamburg

  • Short presentation of the project and the timeline

  • Feedback and problems with the evaluation / data quality

  • Comparison of the various resources with distinction in various orthopedic centers

  • Evaluation results

  • Common problems

  • Take Home Messages


Agenda
CV

ISOC Operating Room Task Force April 5, 2013 Hamburg

Ines Gurnhofer

OR Management – Head of OR Departement Schulthess Clinic Zürich 2003-

Head of OR Departement Orthopaedic Hospital Speising Vienna 1996-2002

ICU Clinical Hospital Zagreb 1989-1995

University of Applied Sciences and Arts Luzern

MAS Management in social and health services 2005-2008

Vinzentinum Health Academy Vienna 1998-2008

Medical School Baden n. Vienna 1996-1997

Medical School Zagreb 1985-1989

OR- Management International Congresses: Vienna, Salzburg, Köln, Berlin, Zürich, Düsseldorf


Task force operating room efficiency comparison
Task Force Operating Room – Efficiency Comparison

ISOC Operating Room Task Force April 5, 2013 Hamburg

OR managementfocuses on maximizing operational efficiencyatthefacility, i.e. tomaximizethenumberofsurgicalcasesthatcanbedone on a givendaywhileminimizingtherequiredresourcesandrelatedcosts.

Operating roomefficiencyis a measureofhowwell time andresourcesareusedfortheintendedpurposes.

Wehavethereforeoptedtoconduct an efficiencycomparisonusingtheoperatingprocessas a basiswiththreephaseswithintheprocess:

Pre-operative process (inductionphase) Delays andotherproblems

Intra-operative process (operatingphase) Staffstructure

Post-operative process (recoveryphase) Nothingspezial


Task force or project t imeline
Task Force OR Project Timeline

ISOC Operating Room Task Force April 5, 2013 Hamburg

  • April 2012 Kick-off Meeting with M. Spielmann, MHA, CEO, Project Leader

  • Mai 2012 Creating a questionnaire for our project

  • June 2012 Sending a questionnaire to ISOC- Clinics

  • July 2012 Deadline for answers

  • November 2012 – March 2013 Analysis - working on project results

  • Today ISOC- Meeting in Hamburg presentation


Feedback and problems with the evaluation data q uality
Feedback and Problems with the Evaluation-Data Quality

ISOC Operating Room Task Force April 5, 2013 Hamburg

Failure to meet the deadlines

Last questionnaires received in Nov. 2013

From additional questionaires that we sent out in February 2013, only 60% return rate

Various questions could not be answered because in some institutions various data points are not available

“Errors using inadequate data are much less than those using no data at all...”

Charles Babbage

1791-1871


Number of o perating rooms per institution
NumberofOperating Rooms (per Institution)

ISOC Operating Room Task Force April 5, 2013 Hamburg


Number of m inutes allocated for o perations per year
NumberofMinutesallocatedforOperations per Year

ISOC Operating Room Task Force April 5, 2013 Hamburg


T otal n umber of o rthopaedic o perations 2011 109 864
Total Number of OrthopaedicOperations 2011 - 109`864

ISOC Operating Room Task Force April 5, 2013 Hamburg


Adjusted u tilisation
AdjustedUtilisation

Adjusted utilisation uses the total hours of elective cases performed within OR block time,

including «credit» for the turnover times necessary to set up and clean up

ISOC Operating Room Task Force April 5, 2013 Hamburg


Start time delay in minutes
Start- time Delay in Minutes

ISOC Operating Room Task Force April 5, 2013 Hamburg


Start time delay for elective cases per or per year
Start – time Delay for Elective Cases per OR per Year

ISOC Operating Room Task Force April 5, 2013 Hamburg

ISOC per day 168 min

ISOC per week 840 min ( 5 working days)

ISOC per year 42000 min ( based on operating 50 weeks per year )

McKinsey&Company

42000 min x 16€

672`000.00 € / 873`808 USD or «700 Operations» - 60 min HIP Prostheses

Delays in the operating room have a negative effect on its efficiency and the working environment

Delays can be attributed to human errors and system deficiencies and the surgical operating room is rife with both!


Most common causes for delays hospital comments
Most Common Causes for Delays – Hospital Comments

ISOC Operating Room Task Force April 5, 2013 Hamburg

  • Patient arrival at day of surgery

  • Transfer of the patient from ward to OR

  • Surgeon and anaesthesia late

  • Surgeons allocating too many procedures to a «300» min session

  • List order changes

  • Surgion defined wrong duration of surgery

  • Not enough induction area (parallel preparations of patients)

  • Long in- between cases changing time

  • Absence of anaesthetic preparation room

  • Preparation room for OR nurse – old building


Delays in or
Delays in OR

ISOC Operating Room Task Force April 5, 2013 Hamburg


Lession to learn
Lessiontolearn

ISOC Operating Room Task Force April 5, 2013 Hamburg

  • Continuous documentation of all delays in OR

  • Detailed analysis of delays and classification by cause

  • Analysis of all operational processes

  • Process- knowledge check and training sessions if necessary

  • Intraoperative time management of surgeons needs to be improved

  • Permanent sensitization about “time loss” in OR and intraoperative inefficient time management

  • Decision-making competence: OR- Management Committee

  • OR- Statute accepted and signed by all Chief- Surgeons

  • CEO and hospital management must be involved to get higher decision competence

  • Trying to solve problems with infrastructure (sometimes impossible if hospitals are old)


Or statute
OR Statute

ISOC Operating Room Task Force April 5, 2013 Hamburg


Pre operative p rocess i nduction phase
Pre-operative Process (Induction Phase)

ISOC Operating Room Task Force April 5, 2013 Hamburg

Preparingthepatientfortheoperation


Recommendations induction phase
Recommendations – Induction Phase

A holding area for the preparation of the patient is very important

Processes run faster with enough staff for patient positioning and parallel working

This affectspreoperativedelaysandreducesthem

Delays in the start can be made up only with difficulties

ISOC Operating Room Task Force April 5, 2013 Hamburg


Where the i nduction takes place
WheretheInductiontakesplace

ISOC Operating Room Task Force April 5, 2013 Hamburg


Situation with anaesthetic p reparations
Situation withAnaestheticPreparations

ISOC Operating Room Task Force April 5, 2013 Hamburg


Patient p ositioning
Patient Positioning

ISOC Operating Room Task Force April 5, 2013 Hamburg


Staff s tructure per operation case
StaffStructure per Operation / Case

ISOC Operating Room Task Force April 5, 2013 Hamburg


Lession to learn1
Lessiontolearn

ISOC Operating Room Task Force April 5, 2013 Hamburg

Induction and patient positioning in OR reduce the efficient utilization of the operating room

Patient positioning for orthopedic surgery is often complex, takes a long time and therefore may block valuable surgical capacities

OR capacities must be maximized for surgical activities

All supporting and accompanying processes need to be relocated away from limited OR space

Otherwise any anesthetic complications may affect OR capacities

Various int. OR projects and publications have shown that induction in the OR adversely affects the overall OR utilization

OR Managers and Architects patronize for the future holding and central induction area

“only the flying aircrafts make money”


Follow up project
Follow-up Project

ISOC Operating Room Task Force April 5, 2013 Hamburg

  • Definition of parameters and time points for assessments

  • Monitoring and critical evaluation of all delays in OR

  • Analyze subspecialty-/ surgeon-specific allocation of OR capacity

  • Implement improvements based on previous assessments of OR efficacy

  • Then reevalute OR efficacy following these implementations