OR Manager November/December 2021 - 21

Scheduling
instruments. And because fewer instruments
were opened, the time for reprocessing
instrumentation decreased.
The committee also began tracking
KPIs and the time it takes to do each of
nine segments of care, beginning with
" In Facility to In Preop " and ending with
" In PACU [postanesthesia care unit] to
Criteria Met. "
Month-to-month trends of these indicators
were analyzed to see if there
was improvement. " Just by virtue of
watching and looking at the data, we
found opportunities, " says Hepburn.
" For example, " she adds, " we found
that some of our novice anesthesia providers
didn't understand the processes
we put into place for the 'In Room to
Anesthesia Ready' indicator. But once
we educated them, they adhered to the
processes. "
Using data to reduce variation
Intuitive provided the robotics team with
data for evidence-based change management,
which they adopted to reduce
variation.
These included standardization of:
* instrument trays
* process for docking (placement of
the robot)
* back table setup
* instrument utilization-trays vs peel
pack.
The team also developed the
" quad, " which is the section of the OR
suite dedicated to the robotics service
line. The quad is made up of four ORs
that are back to back, and each room is
set up in the exact same way.
In between the rooms, in the sterile
core, there are disposable and reposable
instruments. Everything is clearly
labeled and specific to the robotics
service line. Four ultrasonic cleaning
machines have been added, for a
total of five, which has significantly
decreased reprocessing time.
A standard of work was established
for all roles in the OR, and time trials
were done for each segment of care-
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for example, all of the duties that had
to be completed before the patient
entered the room were listed, along
with the amount of time it took to complete
the room setup before the patient
entered.
" We made sure all the work that was
being done was not redundant, and we
assigned specific work to specific roles
so that we were able to be as efficient
as possible, " notes Hepburn. " Because
of this role delineation, everyone knows
what the other person is doing, which
allows for parallel processing, " she
says.
Management of block time
scheduling
Once a standard of work was accomplished,
the steering committee-
with the help of the Genesis team-
developed a new approach for managing
block time scheduling, in which the
robotics surgeons committed to only
performing robotics procedures in their
robotics block time, known as " surgeon
stacking. "
Benefits of surgeon stacking include:
* allowing for optimal utilization of the
block schedules each day
* providing surgeons with consistent
and optimized schedules each week
* giving OR staff predictable work days
when working within block schedules.
" This
took about a year to adopt, "
says Hepburn, " but over time we moved
all nonrobotics blocks out of the robotics
rooms. "
A standard robotics block-drop
procedure for each service line was
instituted. For example, in the robotic
general surgery service line, blocks
drop in 10 business days or 2 weeks.
This allows for " unfettered access " -
any surgeons who do not have robotic
block time can access dropped blocks
for their cases.
Open robotics block time is published
on a biweekly basis to make sure
any surgeon who would like to perform
robotics cases will have access to time.
The robotics clinical coordinator, who
works closely with the schedulers and
the surgeons, sends an email to each
of the surgeon's offices asking about
availability of block time. In addition, if
the coordinator notices that a surgeon
usually books five cases on a given
day and only two are booked, she will
contact the office scheduler to make
sure there are no more cases to be
added before the block drops and time
is made available.
This close coordination also has
been invaluable for implementing
" smart size " blocks. For smart size
blocks, the coordinator looks at block
utilization and suggests to surgeons
that perhaps a Tuesday-Wednesday
block would work better than a Monday
through Friday block because they
are only using a portion of their blocks,
and historically they use the Tuesday to
Wednesday blocks more frequently and
at a higher rate.
Block time coordination also means
that staff members assigned to specific
robotics service lines must be scheduled
to work on the days those surgeons
have their blocks.
" For example, " says Hepburn, " if you
know you're going to have 3 days of a
robotics block or 5 days, you can schedule
the staff members accordingly for
8-hour blocks or 10-hour blocks. "
This system provides consistency
for surgeons and staff alike, which increases
their satisfaction and allows
them to plan for those cases, she says.
Hepburn also notes that surgeons who
thought it was faster to do their cases
laparoscopically were persuaded to
move to a robotics platform because
of the reproducibility of quick turnovers
and standardization.
" In the end, " she says, " by virtue of
standardization, we were more efficient
and able to add more surgeons and
cases and provide better outcomes. "
Continued on page 23
OR Manager | Nov/Dec 2021
21
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OR Manager November/December 2021

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