Palmetto Health Richland (PHR)

Need: to re-design the process to remove variation and potential waste in surgical areas. Process: 3-phase process beginning in summer 2007 in coordination with Dr. Eugene Litvak and the Institute for Healthcare Optimization (IHO). IHO specializes in using queuing theory to mathematically calculate Operating Room and bed demand and sequencing. The design to engage was made by PHR’s senior leadership group, largely comprised of physicians, who had attended a January 2007 Litvak didactic course in Boston.

Phase 1 consisted of separating our non-elective case volume (defined as a patient that clinically needs to have surgery within 24 hours of decision to operate) from our elective case volume (cases with no immediate time constraints). A surgeon sub-committee with representatives from all specialties reporting to OR-PACU Committee was formed. A surgeon chair, Dr. Richard Davis, was elected by his peers to head the sub-committee. All definitions, categories of urgency, policies, and implementation rules were developed and approved by surgeons on this sub-committee. Surgeons developed five urgency categories and set the time intervals for intervention; surgeons also reviewed case data and decided which cases belonged in which urgency category. IHO analyzed six months of actual PHR case data and determined that three non-elective operating rooms should be set aside from 0700-1900 Monday-Fridays, with two rooms covering nights and weekend. Non-elective cases are now sequenced into the three non-elective operating rooms and do not impede elective surgeons.

Phase 2 consisted of re-defining block utilization and squeezing the wasted time out of their block schedule template. The goal is for surgeons to use entire days in their block rather than partial days, arriving at an overall utilization of 90%. This is a journey that involves a good deal of manual calculation – we started at around 56% and now stand at 78% as of Jan 2011. Surgeons gain or lose time based on their utilization. Surgeons on the OR-PACU Committee along with the Senior Medical Liaison for Surgery review and approve all the significant change proposals to the blocks.

Need: to re-design the process to remove variation and potential waste in surgical areas. Process: 3-phase process beginning in summer 2007 in coordination with Dr. Eugene Litvak and the Institute for Healthcare Optimization (IHO). IHO specializes in using queuing theory to mathematically calculate Operating Room and bed demand and sequencing. The design to engage was made by PHR’s senior leadership group, largely comprised of physicians, who had attended a January 2007 Litvak didactic course in Boston.

Phase 1 consisted of separating our non-elective case volume (defined as a patient that clinically needs to have surgery within 24 hours of decision to operate) from our elective case volume (cases with no immediate time constraints). A surgeon sub-committee with representatives from all specialties reporting to OR-PACU Committee was formed. A surgeon chair, Dr. Richard Davisl, was elected by his peers to head the sub-committee. All definitions, categories of urgency, policies, and implementation rules were developed and approved by surgeons on this sub-committee. Surgeons developed 5 urgency categories and set the time intervals for intervention; surgeons also reviewed case data and decided which cases belonged in which urgency category. IHO analyzed six months of actual PHR case data and determined that three non-elective operating rooms should be set aside from 0700-1900 Monday-Fridays, with two rooms covering nights and weekend. Non-elective cases are now sequenced into the three non-elective operating rooms and do not impede elective surgeons.

Phase 2 consisted of re-defining block utilization and squeezing the wasted time out of their block schedule template. The goal is for surgeons to use entire days in their block rather than partial days, arriving at an overall utilization of 90%. This is a journey that involves a good deal of manual calculation – we started at around 56% and now stand at 78% as of Jan 2011. Surgeons gain or lose time based on their utilization. Surgeons on the OR-PACU Committee along with the Senior Medical Liaison for Surgery review and approve all the significant change proposals to the blocks.