Top 10 OR Dashboard
Metrics
Pamela Ereckson Fox, MD
OR Dashboard Metrics
• Volume
– Case Volume
– Case Minutes
– Case Minutes by Time of the Day
• Utilization
– OR Utilization by Day of Week
– Block Utilization
2
OR Dashboard Metrics
• Operational Stats
– Turnover Time
– On Time Starts
– Cancellations
– Add Ons
– Overtime Minutes
Case Volume
• Reflects total number of cases over time
• Compares inpatient to outpatient volumes
• Allows you to follow growth as well as seasonal
variation
– The following sample hospital has a decrease
in volume in August which reflects a time
when many surgeons take vacation
• Average number of cases per OR per year in best
practice ORs
– Inpatient 900 cases per OR/year
– Outpatient 1400 cases per OR/year
Surgical Case Volume Trend
700
600
500
Oupatient
400
300
200
100
0
Inpatient
Total
Case Minutes
• Reflects total number of minutes of surgery per
month.
• Also reflects growth as well as seasonal variation
• Comparison between volume and minutes helps in
determining growth patterns
– Increase in volume with a small increase in
minutes usually means a growth in smaller
cases usually outpatient
– Small increase in volume with a larger
increase in minutes usually means a growth
in longer cases usually inpatient
Surgical Case Minutes Trend
70,000
60,000
50,000
Outpatient
40,000
30,000
20,000
10,000
0
Inpatient
Total
Case Minutes by Hour of the Day
• Allows you to look at what percentage of case
minutes are completed in each shift
• Goals
– 90% of minutes completed between 7am-3pm
– 95% of minutes completed by 5pm
• Following sample hospital graph shows a process
improvement project that started in June at 84%
completion by 3pm with increase of completion to
90% over 6 months. Processes addressed were
• Start time
• TOT
• Revision of block schedule
• Staffing levels
Case Minutes by Hour of the Day
100%
95%
90%
11pm-7am
7pm-11pm
5-7pm
85%
3-5pm
7-3pm
80%
75%
June
July
August
Sept
Oct
Nov
Dec
Jan
Feb
OR Utilization by Day of the Week
• Reflects total OR utilization on each day of the week
• The goal is to even out the utilization so there is little
variation between the days of the week
• Goal in best practice ORs is 75%-80% total OR
utilization. This allows adequate “flex” in the system
• The following sample hospital revised its block
schedule to allow better utilization of Thursdays and
Fridays
OR Utilization by Day of the Week
Goal >75%
August
100%
Sept
90%
80%
Oct
70%
60%
Nov
50%
Dec
40%
30%
2008
20%
10%
Jan
0%
Monday
Tuesday
Wed
Thurs
Friday
Total
Feb
Block Utilization
• Block utilization is calculated by surgeon/service
• It is best to use adjusted utilization in order to not
penalize a surgeon for TOT
– Adjusted Utilization= total block minutes
utilized +TOT/ total block minutes available
• Goal is 75% block utilization in order to maintain
block. When decreasing blocks according to
utilization you should decrease by days of the month
not hours of the day
– Example: A surgeon w/ 50% utilization of a
block on Monday would have the block
reduced to either the 1,3,5 Monday of the
month of the 2,4 Monday
Block Utilization
Average Block Utilization by Surgeon
Goal = 75%
Recent 3 Mo
Recent 6 Mo
100%
90%
80%
70%
3 mo
avg
60%
50%
40%
30%
20%
10%
0%
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
13
OR Start Times
• Defined as time patient enters the operating room
• Usually monitored at exact time and within 10
minutes
– Example: 0720 exact time while also
monitoring the 10 minutes later at 0730
• Goal is 90% within 10 minutes
• Sample hospital on next slide reflects a PI project
that improved start time from 65% to 85%. Issues
addressed were
– Communication between team members
– Monitoring of start times
– Communication to surgeons the importance
of on time starts by the OR committee
– Change in Preoperative Patient preparation
OR Start Times
Goal >90%
90%
Percent On Time
85%
80%
70%
65%
68%
68%
69%
70%
70%
74%
84%
75%
70%
65%
60%
50%
720
40%
730
30%
20%
24%
28%
21%
22%
20%
21%
25%
21%
25%
24%
24%
10%
0%
Feb
Mar
Apr
May
June
July
Aug
Month
Sept
Oct
Nov
Dec
Jan
25%
Average Turnover Time
• Turnover time is calculated as patient out of the
room to next patient in the room
• We usually follow same surgeon turnovers since
there is quite a bit of variability when turning over
between 2 different surgeons or services
• Goals
– Outpatient 10-20 minutes
– Inpatient 30-40 minutes
• Sample hospital slide shows a PI project that begin
in April. Issues addressed included
– Staffing Levels
– Communication between team members
– Preoperative patient workup
Average TOT
Average OR Turnover Time
IP 30-40 min, OP 10-20min
40
35
35
33
31
Minutes
30
33
32
26
25
24
20
23
23
23
24
24
19
18
15
10
5
0
Jan
Feb
March
April
May
June
July
Month
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Overtime Staffing Minutes
• Reflects amount of overtime minutes paid to OR
staff
• Sample hospital PI project decreased overtime
minutes significantly over a 4 month period by
addressing
– On time starts
– TOT
– Staffing levels by time of the day
– Block Scheduling
• Gaps in schedule
• Overbooking.
– Example: A surgeon with an 8 hour block routinely
runs 10 hours. The block should be adjusted to 10
hours and staffing levels changed to meet this need
Overtime Minutes
5000
4680
4350
4000
3390
3345
3000
2715
2400
2205
1860
2000
1665
1860
1275
1000
615
285
1215
1020
1215
480
450
210
0
October
1725
November
3:30-5:30pm
Decmeber
5:30-7:30pm
January
7:30-11:30pm
February
Total
Cancellations
• Usually monitor same day cancellations
• Factors that impact cancellations
– Preoperative preparation including
preanesthesia testing and patient education
• Sample hospital slide shows a PI project for
preoperative preparation that included a
pre-anesthesia testing clinic, that provided not only
testing but patient education and financial
counceling/insurance verification
• Goals
– <1% for an outpatient setting
– <10% for a major trauma center
% Cancellations
Goal <1%
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
Sep Oct Nov Dec Jan Feb Mar Apr May June Jul
'08 '08 '08 '08 '09 '09 '09 '09 '09 '09 '09
% Cancellations
Add Ons
• Reflects adequate open/urgent time
– Open time is time available to anyone and can
be booked in advance. This accommodates
the non-blocked surgeons
– Urgent time is time available starting 24 hours
before. This accommodates many cases that
need to be done urgently but are not
emergent. Many general surgery and urgent
ortho cases fit into this category
• Goal < 20%
% Add Ons
Goal < 20%
30%
25%
20%
15%
% Add Ons
10%
5%
0%
July
August
Sept
Oct
Nov
Dec
Jan
Feb