Pre/Post OR Bed Utilization            Case Study        Brittany Hagedorn           2/29/2013
AgendaI. Scenario ScopeII. Key FindingsIII. Operating Alternatives
I. Scenario Scope     The original project objective was to understand the implications on   inpatient floors of an overfl...
II. Key FindingsOriginal Scope Results    Based on expected patient volumes, all three scenarios resulted in concerns     ...
II. Key FindingsPatient Delays        By utilizing labels and a robust set of information store spreadsheets,        we we...
II. Key FindingsOperational Implications – Sample Day    By simulating each day individually, we were able to uncover the ...
II. Key FindingsBlock Time Utilization       The statistically relevant driver of block time utilization was the ratio of ...
III. Operating AlternativesPre-Admission Testing  Option 1: Reclaim the 4 preadmission testing rooms for pre/post patient ...
III. Operating AlternativesObservation Patient AssignmentOption 2: Release an increased number of observation patients to ...
Appendix
AssumptionsAssumption                                                 RationaleHistorical surgery durations and patient mi...
Detail – Block Time Utilization by OR                                                                                     ...
Detail – Daily Volume & Utilization   • Daily case volume ranges between 47-75, with an average of 62   • Daily block time...
Detail – Volume Breakdown     Average Volume by Service Line                       Average Volume by Patient Type • Outpat...
Key Driver – Block Time Utilization (weekly)                                   • Utilization calculated as                ...
Operational Alternative – Family use Waiting Room                              Family Remains in Pre/Post    Family Stays ...
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Improving Healthcare with Simulation - Pre/Post OR Bed Utilization

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Brittany Hagedorn presented her findings at the recent Simulation in Healthcare Dinner sponsored by SIMUL8.

The original project objective was to understand the implications on inpatient floors of an overflow policy that would be used to manage post-surgery observation patients. Based on the simulation results, the scope quickly expanded to address anticipated bed capacity shortages.

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Improving Healthcare with Simulation - Pre/Post OR Bed Utilization

  1. 1. Pre/Post OR Bed Utilization Case Study Brittany Hagedorn 2/29/2013
  2. 2. AgendaI. Scenario ScopeII. Key FindingsIII. Operating Alternatives
  3. 3. I. Scenario Scope The original project objective was to understand the implications on inpatient floors of an overflow policy that would be used to manage post- surgery observation patients. Based on the simulation results, the scope quickly expanded to address anticipated bed capacity shortages.
  4. 4. II. Key FindingsOriginal Scope Results Based on expected patient volumes, all three scenarios resulted in concerns about OR delays, as well as the need for additional observation beds. Scenario Outcomes Observations to Floor Full 2012 2017 Schedule Patient 15,031 15,911 16,120 VolumeDays with 67% 75% 77% DelaysPatients 6 daily 9 daily 10 dailyDelayed# Patients 1.3 daily 2.0 daily 2.1 daily to Floor
  5. 5. II. Key FindingsPatient Delays By utilizing labels and a robust set of information store spreadsheets, we were able to export patient-level detail that allowed us to conduct a like-real-life analysis on the causes of delays. Minutes per Delay Patients• Delays are not consistent across days of the week, which suggested that there were specific scheduling issues causing delays.• Based on an analysis of variance (ANOVA), same-day volumes for two specialties and observation patient carry-over were determined to be the key drivers.
  6. 6. II. Key FindingsOperational Implications – Sample Day By simulating each day individually, we were able to uncover the cause of delays. As patients exited the OR, they utilized an increasing proportion of the available beds, preventing new patients from being prepped for the OR. Pre/Post Beds in Use ORs in Use The ORs in use has a bimodal shape because the pre/post bed shortage caused delays in patients being prepped for their procedure. The second surge in volumes represents delayed patients finally getting through pre-op into the OR.
  7. 7. II. Key FindingsBlock Time Utilization The statistically relevant driver of block time utilization was the ratio of specialty-specific block time to average procedure duration.• The mismatch between block time length and expected procedure duration was the primary driver of low utilization.• For example, the CVS ratio is just about 2.0, which does not leave room for an additional case if the first scheduled case is much longer than average.
  8. 8. III. Operating AlternativesPre-Admission Testing Option 1: Reclaim the 4 preadmission testing rooms for pre/post patient care.There was a potential trade-off between the The ideal number of pre/post patient bedsnumber of pre/post beds and OR delays. is dependent on risk tolerance.
  9. 9. III. Operating AlternativesObservation Patient AssignmentOption 2: Release an increased number of observation patients to an inpatient floor. There was a potential trade-off between observation patients transferred to an inpatient floor and expected delays.
  10. 10. Appendix
  11. 11. AssumptionsAssumption RationaleHistorical surgery durations and patient mix is an Due to the clinical nature of these values, thereaccurate representation of these values in the future is no reason to expect them to change radicallyAggregation into 7 service lines (CVS, Aggregation was based on clinical judgment,Neuro/Ortho/Spine, ENT, Gynecology, General, volume of procedures, and was validatedUrology, Other) statisticallyMaximum number of add-ons per day is 10 Based on historical ratesObservation patients are sent to the floor only if there Based on logical patient flowis another patient waiting for pre-opNo emergency cases Designed to predict performance on normal days, not to plan for unexpected emergenciesAll add-on cases are performed at the end of the Per discussion with Starlascheduled day, and are General casesFully schedule any block time available, assuming Designed to test the “worst-case” scenarioplenty of demand to use capacitySeasonality was not considered Per discussion with StarlaPatients arrive on time and are ready for surgery Simplifying assumptionwithin their allotted prep time
  12. 12. Detail – Block Time Utilization by OR Yearly utilization calculated based on 260 12-hour days per year• There is potential to increase OR capacity by focusing on improving utilization of: • ORs 1-3: underutilized due to their CVS specialty • OR 7: underutilized due to the block time being broken up between services • OR 14: not currently scheduled to be open every day* Note: OR9 seems to have more than 100% because the calculation is based on a 12 hour day and OR9 has Add-On cases that run past scheduling
  13. 13. Detail – Daily Volume & Utilization • Daily case volume ranges between 47-75, with an average of 62 • Daily block time utilization ranges between 61%-84%, with an average of 75% • Total yearly volume is approximately 16,120
  14. 14. Detail – Volume Breakdown Average Volume by Service Line Average Volume by Patient Type • Outpatient is the largest patient type • General is the largest service line (driven by assumption that add-ons are general cases) • Note: Case volume is not equivalent to hours of OR utilization
  15. 15. Key Driver – Block Time Utilization (weekly) • Utilization calculated as # minutes used / # minutes in the block • Utilization varies widely depending on the service line and the day of the week. • Targets for improvement could include CVS block length and Thursday block arrangement
  16. 16. Operational Alternative – Family use Waiting Room Family Remains in Pre/Post Family Stays in Waiting Room Room during Surgery during Surgery % Days with Delays 77% 45% 10 daily 1 daily # Patients Delayed (2,647 yearly) (287 yearly) # Observation Patients 2 daily 0 yearly to Floor 417 yearly • Option 3: Ask family to stay in the general waiting room during surgery in order to reclaim the pre/post room for the next patient • Risks: • Simulation does not account for pre/post room turnover time, which will use up some of the recovered time and reduce the actual impact of this change • This change would increase the need for seating in the general waiting room, which may not have enough capacity

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