Agenda

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. NumberofOperating Rooms (per Institution) ISOC Operating Room Task Force April 5, 2013 Hamburg

8. NumberofMinutesallocatedforOperations per Year ISOC Operating Room Task Force April 5, 2013 Hamburg

9. Total Number of OrthopaedicOperations 2011 - 109`864 ISOC Operating Room Task Force April 5, 2013 Hamburg

10. 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

11. Start- time Delay in Minutes ISOC Operating Room Task Force April 5, 2013 Hamburg

12. 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!

13. 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

14. Delays in OR ISOC Operating Room Task Force April 5, 2013 Hamburg

15. 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)

16. OR Statute ISOC Operating Room Task Force April 5, 2013 Hamburg

17. Pre-operative Process (Induction Phase) ISOC Operating Room Task Force April 5, 2013 Hamburg Preparingthepatientfortheoperation

18. 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

19. WheretheInductiontakesplace ISOC Operating Room Task Force April 5, 2013 Hamburg

20. Situation withAnaestheticPreparations ISOC Operating Room Task Force April 5, 2013 Hamburg

21. Patient Positioning ISOC Operating Room Task Force April 5, 2013 Hamburg

22. StaffStructure per Operation / Case ISOC Operating Room Task Force April 5, 2013 Hamburg

23. 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”

24. 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

25. ISOC Operating Room Task Force April 5, 2013 Hamburg Thanksfortheattention!