Operating rooms typically account for a significant portion of a hospital’s expenses, not to mention as much as 70% of its revenue. This was certainly true at Adventist Health White Memorial.

THE PROBLEM

When the hospital looked at its data, however, it found that unused operating rooms might be creating a strain on finances and operations. Staff recognized that turnaround times in the OR – and subsequent wait times – were reducing surgical capacity, revenue and patient satisfaction.

“We also identified that our workflows relied heavily on manual data entry and communication between clinical and ancillary care teams, which often was inefficient and caused case delays,” said Randy Saad, director of perioperative services at Adventist Health White Memorial. “When there were case delays, communications about it often were disparate, which meant key stakeholders did not always receive timely notifications.”

These issues increased confusion and frustration as well as created further delays throughout the day, which then made the experience that much worse for patients, families and staff.

“Our team also recognized that we needed detailed reports to provide deeper insights into how long processes actually took at each point in the care continuum and what the necessary staffing levels should be,” Saad explained. “We had aggregated a lot of data to identify the problems, but we needed a data management and tracking system to provide Adventist Health White Memorial with the ability to predict the scheduling blocks and staffing levels.”

PROPOSAL

Adventist Health White Memorial turned to health IT from vendor Tagnos. Its real-time location system (RTLS) technology offered the ability to locate patients in real time, regardless of where they were in the hospital, which would help the hospital improve turnaround times and the patient experience while also better matching staffing levels with the surgical care demand, Saad said.

Tagnos also showed the hospital how it could increase and standardize communication between the surgery teams and ancillary staff so that all team members could be updated quickly and automatically.

"Dashboards and easy-to-create reports enable the hospital to more accurately predict patient flow volume, staffing needs, and track and analyze time-saving performance in every phase of the patient journey."

Randy Saad, Adventist Health White Memorial

“One other issue the vendor could address was the fact that Adventist Health White Memorial staff had no way to automatically capture and share critical workflow movements, like patient wheels in and patient wheels out,” Saad said. “They were reliant on timestamps that were manually input by the clinical staff. The timeliness and accuracy of these inputs were inconsistent, which meant the ancillary teams had no real visibility into the patient status or location.”

The vendor offered a system that could track wheels in and wheels out, automatically track time between care points, and ensure data accuracy to increase OR efficiency, staffing effectiveness and patient satisfaction, Saad added.

MARKETPLACE

There are many vendors of real-time location system technology on the market today, such as CenTrak, GE Healthcare, Hewlett-Packard, Midmark RTLS, Mojix, Siemens, Skytron, Stanley Healthcare and Zebra Manufacturing Solutions.

MEETING THE CHALLENGE

Part of the Tagnos system was to tag each patient with real-time location systems with RFID tags to enable the hospital to track location and movement electronically. The software analyzes and aggregates data from the tags along with information from hospital systems to provide real-time alerts to the surgical and support teams during every phase of the OR process.

That way, the rooms do not sit empty and providers are ready to deliver care. Data from the system automatically is shared throughout hospital systems – including to waiting room monitors – so that updates are provided to families about patient transitions. That alone has had a positive effect on patient and family satisfaction with the Adventist Health White Memorial experience.

The Tagnos system is integrated with Adventist Health White Memorial’s Cerner electronic health record so that once a nurse tags a patient at registration, the data is allowed to flow into the platform with timestamps. It also automatically is exported into the EHR. The capturing of accurate data at every phase is crucial to productivity and efficiencies improvements, and also because billing is based on OR time.

“There also were other improvements from implementing the technology,” Saad reported. “Because of the RFID tags, messages about patients in pre-op are now delivered automatically at every stage of transition and nurses can access information from the app on mobile devices. They also can send customized messages through mobile technology.”

Outside of the OR, clinicians, management and staff can track patient progress on a dashboard available via the app. The notifications save minutes, which may add up to hours when aggregated across the entire day. These optimized communications result in optimal efficiency, which is what the hospital wanted, Saad said.

RESULTS

After implementing the system with its RTLS tracking and instituting changes that came from insights from the system, Saad said, there were several improvements:

• Reduced wait time from 2.5 hours to 2 hours.
• Environmental services (clean up and prep) response time decreased 104 seconds, or 61%.
• Anesthesia tech response time improved from 38% to 51%.
• OR room TAT decreased from 28.0 minutes to 24.6 minutes, placing the hospital in the top-quartile benchmark hospital comparison: First Case On-Time Starts (FCOTS) goal for top quartile, 72%; hospital FCOTS 2019 goal, 80% (reset Jan 1, 2019); August hospital FCOTS actual, 82%; cut staffing expenses by $498,000.
• Increased patient satisfaction scores from a significantly low score to 90% “would recommend.”

At five turnarounds per day multiplied by six ORs, the 3-minute improvement saves 90 minutes per day. By multiplying 90 minutes per day by the $41 per-minute cost of each OR, the hospital is saving an estimated $974,160 per year, Saad reported.

“Staffing expenses also decreased by $498,000 due to new real-time analytics and reporting capabilities,” he said. “Dashboards and easy-to-create reports enable the hospital to more accurately predict patient flow volume, staffing needs, and track and analyze time-saving performance in every phase of the patient journey, including total length of stay.”

ADVICE FOR OTHERS

“Adopt ways that foster a higher level of teamwork in the OR, remove the uncertainty about coordinating team responses and taking a hard look at staff scheduling needs,” Saad advised. “Automated time-stamping, accurate reporting, and reliable and timely communication are tantamount to operational success.

“Other health systems could learn that by visualizing how tasks are interrelated, they, too, could improve operational efficiency and reduce costs while increasing surgical productivity and revenue,” he concluded. “By focusing on our ultimate goals, we have realized substantial improvements, driven positive change, optimized outcomes and improved the patient experience.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
Healthcare IT News is a HIMSS Media publication.