Five Opportunities to Improve Perioperative Efficiencies and Achieve Optimal Margins
Surgical procedures make up 65% to 70% of a typical hospital’s revenue.1 Some estimate the impact on margin at up to $4,000 per OR hour.2 Yet, every surgical procedure brings an element of risk that can cause harm not only to the patient, but to the hospital’s reputation, quality scores, and bottom line.
It is essential that hospitals develop and maintain an optimally performing perioperative environment. But it can be challenging to identify, capture, measure and report data related to anesthesia processes and outcomes.
By assessing the following five areas, hospitals can begin to identify opportunities for improvement that can help them achieve the highest quality outcomes and maximum revenue potential.
Hospital personnel in the OR, along with Anesthesia practice personnel, are a hospital’s greatest expense and a top variable impacting profitability and safety in the perioperative environment. Therefore, achieving optimal margins begins with appropriate staffing allocation. Analyzing historical data and employing industry benchmarks gives hospitals the insight needed to plan staffing levels. Underutilized OR and Anesthesia staff is cost-prohibitive while over-utilized staff can lead to errors, adverse events, staff turnover, and a poor patient experience.
On-Time Procedures and Day-of-Surgery Cancellations
Patient scheduling is key to reducing delays and cancellations. Scheduling procedures based on a predictive index by procedure type should be created to ensure alignment of case types with appropriate scheduling, i.e., the highest levels of case predictability should be scheduled earliest, and the longest or those with the least predictability should be scheduled toward the end of the day. Hospitals should aim for a 90% first-case on-time start.3
Besides scheduling processes, other elements affecting on-time metrics include incomplete patient charts, missing labs or consents, and special care items that weren’t ordered. These all become cogs in the perioperative process and inhibit on-time procedures. Hospitals should track such interruptions, their source, and employ proactive processes to ensure they are ready when the patient arrives. Ideally, all information and care items are ready the day before the procedure.
Day-of-surgery cancelations can reach up to 15% in some hospitals, and can be a significant factor in costly overstaffing.4 One study estimated costs of over $4,500 per each cancelled case.5 Poor pre-admission testing (PAT) processes are often to blame.6 Hospitals should aim for less than 5% cancellation rates.7
It can be challenging to accurately predict turnover times on days when more complex procedures are scheduled, especially where unexpected complications are more likely to occur. Likewise, some procedures may end much faster than normal. That said, hospitals need to aim for an average of no more than a 21-minute turnover time to achieve a best-practice OR utilization rate of 75%.8
It is important that post-op services are staffed to match the volume of scheduled procedures to avoid delays in discharge. As well, hospitals should be tracking delay reasons, such as the need for medication reversals or missing patient information like post-surgery care guidelines, follow-up appointments, etc. Hospitals should aim for post-op delays of 10% or less.9
Nationally, only 19% of caregivers say they have the data needed to act in real time during patient care.10 This lack of insight is a roadblock to effective decision-making in both administrative and clinical processes. Starting at admissions and continuing through recovery and discharge, each staff member needs access to timely, complete patient information. This type of transparency provides a greater understanding of each patient’s unique needs, which enables better communication and a higher level of engagement between patients and caregivers throughout the continuum. When both patients and staff are fully engaged, the likelihood of errors is reduced.
The First Step
Every perioperative workflow from pre-op to discharge must run at peak performance to achieve quality outcomes and optimal financial performance. This requires hospitals to continuously track and measure efficiencies for each step of the patient process. The first step should be a complete assessment of the perioperative environment. From there, hospitals will have greater insight into problematic trends and opportunities for improvement. A lack of such insight can lead to revenue erosion and reduced long-term viability.
PhyMed Healthcare Group, a physician-led and owned leader of anesthesia and pain management services, helps hospitals more easily track and report trends and their impact in accordance with MIPS guidelines across multiple markets. PhyMed consistently achieves process improvements such as those related to Protective Lung Ventilation, while showing statistically correlated decreases in post-op pneumonia. PhyMed is committed to patient safety and operates under a Patient Safety Evaluation System in partnership with the Anesthesia Quality Institute. In addition, PhyMed is implementing an enterprise-wide patient satisfaction strategy that will gather feedback allowing providers to react in real-time.
Staffing Optimization. PhyMed, gives hospitals the insight they need to more effectively achieve staffing optimization. Hospital partners receive several actionable reports such as Interactive Transition and Hand-off Report, Daily Volume Report, and the Efficiency Heat Map. Through continuous monitoring and measuring, hospitals are able to make real-time staff decisions that are more impactful.
On-Time Procedures and Day-of-Surgery Cancellations. To address same-day cancelations, PhyMed has developed A Daily Volume report makes it easier to proactively identify problematic trends and impacts. Hospitals using the solution average a cancelation rate of just around 1%.
Post-op Delays. PhyMed recently developed an educational program around Neuromuscular Blockades that addresses appropriate patient monitoring and utilization of the most appropriate reversal agent. TOF documentation greatly improved and Sugammadex utilization has been maintained.
Data Transparency. PhyMed’s proprietary EMR is integrated into the hospital partner’s clinical system and is accessible from mobile tools such as tablets. This offers providers ready access to actionable information during the entire care episode.