OR Manager November/December 2021 - 29

Leadership
Lay groundwork for strong 2022 with quick win in OR efficiency
he new year is just around the
corner, and it will bring new challenges
for OR leaders as well as
fresh opportunities to improve clinical,
financial, and operational performance.
The typical surgery department is
a " target-rich environment " : low utilization,
long turnover times, inefficient
charge capture, poor documentation,
high supply costs, and low protocol
adherence. Success in any of these
areas will represent real progress for
the department, so how do OR leaders
choose where to focus their energy?
One common mistake is to aim for
a " big win " by starting with a major efficiency
problem. The trouble is that the
biggest problems are usually the most
complex. Performance improvement initiatives
that tackle complicated issues
without the right preparation usually get
bogged down and lose momentum.
Instead of trying to kick off 2022
T
with a big win, our recommendation is
to start with a quick win-a relatively
straightforward project that will produce
a noticeable gain in efficiency while creating
forward momentum for more ambitious
initiatives.
A good place to start for most hospital
ORs is to improve the department's
first-case on-time start (FCOTS) rate.
An FCOTS initiative can be launched
quickly and produce fast results in both
operational efficiency and surgeon satisfaction.
Most important, it can provide
a valuable template for achieving much
more significant improvements in clinical
and financial performance.
Set target and work backwards
One advantage of starting with FCOTS
is that there is only one measure of
success-the patient is in the room,
prepped and ready for their procedure,
at the scheduled start time. No complex
analysis is necessary to get started.
Begin with the OR's first-case start time
and reengineer staff and patient activities
as needed to make sure the process
hits the target consistently.
First, one clarification: OR leadership
teams that undertake an FCOTS
initiative should first focus on nursing
and operational processes, not on the
behavior of surgeons or anesthesia providers.
Why? Most surgeons arrive late
to the OR because they have learned
to expect that their patients will not be
ready when scheduled. Before OR leaders
can ask surgeons to start arriving
on time, they must first demonstrate
that patients will be ready on time.
The basic methodology is to work
backward from the first-case start target.
The timeline below lists key activities
and milestones preceding " patient
ready. "
Minutes
prior
105
75
40
35
30
15
10
10
5
5
Late
start
Activity or milestone
Patient arrives at
registration
Patient in preoperative
holding
OR staff attend morning
huddle
Staff arrive in OR, open
rooms, set up and count
Preoperative RN completes
patient assessment
Surgeon completes H&P
update and consent and
marks site
Preoperative RN/OR circulator
do final chart review
OR RN completes handoff
with preoperative RN
Anesthesia completes
patient assessment
Wheels unlocked and
patient en route to OR
Patient in OR
Delay code identified
and entered into EMR
Using this timeline as a basic template,
the focus of an FCOTS initiative
is choreographing all the staff movements,
clinical activities, and information
flows that contribute to first-case
readiness.
OR leaders can adjust the template
as needed. For example, the preoperative
holding area in some hospitals is
a considerable distance from the OR.
These departments may need to allow
more than 5 minutes for transporting
patients to their surgical suite. Consider
conducting a " time in motion " study to
account for transit times between various
locations.
FCOTS tips and strategies
Filling out the FCOTS timeline is relatively
straightforward. The more challenging
part is ironing out the practical
wrinkles that prevent smooth process
flow. Experienced OR managers have
developed several tactics, strategies,
and process fixes to facilitate first-case
efficiency:
* Check vendor policies. Issues with
vendor supplies can lead to case
delays. OR leaders should revise
their vendor policy to specify that all
trays must be on site in the hospital
48 hours before a case. Confusion
sometimes arises around sterilization.
AORN guidelines require all instruments
and implants to be sterilized
on-site by hospital staff, not offsite
as part of the vendor's process.
* Set a hard limit on charts. Missing
lab results, patient assessments,
and other chart components can
also cause cases to start late. Have
OR staff contact surgeon offices two
days before scheduled cases to follow
up on any missing chart information.
Notify them that if the information
is not provided by 24 hours
before the scheduled start time, the
procedure will be moved out of the
first-case time slot.
* Bring some communication inhouse.
Some hospitals allow surgeon
offices to communicate expected
arrival times to patients. This
can lead to mistakes and confusion,
resulting in delays. Hospitals should
Continued on page 30
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OR Manager November/December 2021

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