OPERATING ROOM DASHBOARD Virginia Chard, RN, BSN, CNOR Pen Bay Medical Center Rockport, ME Today’s Healthcare Challenges It’s a new day in how we deliver and how we are paid for delivering patient care. Healthcare reform has brought new strategies, processes, and innovations to the table. • Affordable Care Act • Accountable Care organizations • Meaningful Use • Value Based Purchasing New emphasis going into the future: • Quality • Performance • Accountability • Efficiency What this means for the Us • New strategies for efficiency, cost containment, revenue enhancement • New funding- pay for performance, bundling • Improved utilization of space, time, human resources Strategic Plan Our overall mission: • Offer safe, highest quality patient care and customer service to our community • Increase patient, surgeon, staff, and anesthesia engagement and satisfaction • Create potential for new business opportunities The Journey • Engaging the executive Team in our plans and expected outcomes • Defining the key stakeholders and their roles in the process • Identifying needed resources (i.e. IT) to support the data gathering • Developing a format to present the data in a consistent, concise package • Building communication channels to share our data and move our goals forward as a team Who owns this journey? Identify Stakeholders: • Executive team members • Medical Director • Chief of Surgery • Chief of Anesthesia • Surgical Director • Department Managers-OR/SPD, PREP, Surgical Care • Front line staff Facts of data management • Most health care facilities and operating rooms maintain databases and generate dashboards that help the management evaluate its performance; Multiple genre of data has been collected in perioperative service: – Clinical outcome: e.g. Surgical Care Improvement Project (SCIP) measures – Institutional initiatives: e.g. patient satisfaction rate – Risk management data: e.g. medication errors – Operational efficiency: e.g. first case on-time start – Financial performance: e.g. supply cost/ case The Game Plan • • • • • • • • Assessment of where we are Team Collaboration across all disciplines Education and Communication Stakeholder ownership and involvement Development of key performance indicators Process changes identified Implementation of identified changes Sustainability Where We are Stakeholder Participation Education/Communication Ownership/Involvement Key Performance Indicators • Monitor and improve turn around times • Monitor and improve first case start times • Monitor and improve/right size block utilization • Monitor and improve booking accuracy The Surgical Dashboard • • • • Why – To report surgeons’ operational and financial performance – To maximize block utilization How – Retrieve data from ORIS, preference card, supply chain master item file to generate the comprehensive report What – Surgeon scorecards satisfy the needs of block management and present the complete picture of surgeon performance related to OR operations – Key Performance Indicators are in line with OR performance dashboard, e.g. case volume, first case on time start – Block utilization, out-of-block surgery minutes When – Monthly report for review and report – Quarterly report for OR leadership’s decision on block reallocation Data Management Challenges in OR: • Data accuracy – Many ORIS do not provide data-cleansing functionality - “Garbage in garbage out” – Accurate, complete data is essential to an effective performance dashboard • Analytical skills and experiences in OR data management – DRIP – Data Rich Information Poor – Let the numbers speak, “gut-feeling” is not always right • Buy-in of surgeons and clinicians – Data and information needs to be presented in an intuitive and informative manner – Increase data transparency and data sharing with clinicians • Culture change – It takes time for data-driven decision making to Gain Ground in hospital and perioperative management The Tools PBMC Surgeon Utilization Report PBMC Surgeon Utilization Report Reserved Block Minutes Use PBMC Surgeon Utilization Report •Minutes in Regular Hours •Estimated vs. Actual Minutes •First Come, First Served Minutes PBMC Surgeon Utilization Report •Day Surgery •Emergency Minutes In/Not In Regular Hrs Dashboard detail –specialty group block time First Case Start Time First case start is defined as the time the first scheduled patient of the day enters the OR On time is defined as patient in the room by 0735 or within 5 minutes of scheduled start time Detail First Case Starts 120.0% 100.0% 80.0% >30 min 60.0% 21-30 min 11-20 min 40.0% 20.0% 0.0% 6-10 min on time Turn Around Times Definition of Turn Around Time: Patient out of the room time to patient into the room time Turn Around Times 30 25 20 15 45 min 60 min 10 5 0 120 min OUTCOMES – A centralized standard report depicting a complete picture of OR operational performance – A continuous measurement mechanism demonstrating performance trend – An effective tool helping identify performance improvement opportunities – An intuitive communication venue facilitating decision making process The rest of the story Turn Around Time – • Initial average 27 minutes • Current Average 22 minutes First Case Starts• Initial performance average- 62% • Current performance average- 81% Results achieved by collaborative changes in processes by surgeons, surgical staff and Anesthesia Block Utilization Work is ongoing as we develop communication mechanisms to keep surgeons informed of OR utilization and their individual performance within their blocks Several successful changes have already been implemented to support block utilization and efficiency Questions???