The Kamloops emergency surgery booking system is an all electronic system that combines secure display, SMS notification, custom analytics and digital archiving to radically improve on current static systems. Improvements in team coordination, efficiency, patient safety, stewardship and transparency are all anticipated at a modest cost. (Investors and Supporters Welcome)

1. Introducing:
B – SOR – E
Booking System for Operating Room Emergencies
PARTICIPATING PHYSICIANS AND SURGEONS
FEBRUARY 2017
Dr. Simon Treissman MD FRCSC
Royal Inland Hospital
Kamloops, BC, Canada

2. We have a problem…
“Too many” emergency
Cases…….
(eight per day)
….”not enough” OR time
3. Unsatisfactory
outcomes
1. Delays
2. Longer
wait times

3. We have a problem…
…Disruptive physicians
Surgeons were gaming the static ER booking system
…surgeons were
“wigging out”.
…surgeons were acting in an
immature manner…..

4. We have a problem….
Understanding the problem…
Part of the problem is inefficiency
•Static “pen on paper” system
•Illegible writing
•Inflexible system
•Poor archiving / integration
•Unnecessary phone calls
”fix it”…..

5. We need a solution…
 We needed a digital emergency OR
booking system that get’s into the DNA of the
problem….
Display
Notification
Analytics and Archiving...
….we needed a solution….
How?

6. “B – SOR - E” Materials & Methods
Design and preparation of booking system.
Screen # 1
(pre-op)
Screen # 2
(post-op)
Cases added at the bottom
Cases travel up
Colour coded
Cases travel down
Completed cases
Archived to USB stick
Every 24 hrs for analytics
Notification
We have flow!

7. “B – SOR - E” Materials & Methods
Achieving Notification via SMS.
Short Message System (SMS) gateway by SwiftR
for
notification of stakeholders.
We called for your patient !

8. “B – SOR - E” materials & methods
Achieving Analytics on the acquired data
Analytics software by TableauR
for real time analytics
(About 5 s)
Software

9. “B - SOR – E” Materials and Methods
The booking planetary system…
 Why is it better to look at emergency surgery wait
lists first?
Urology Elective cases
(Several hundred different cases)
Cancer
Non-obstructing Kidney Stones
Benign Prostate Disorders
Scrotal Abnormalities
Benign Kidney Disorders
Elective Sterilization / Reversal
Incontinence
Urology Emergency Cases
(Seven different basic cases)
Obstructing Stone
Acute scrotum
Bladder Outlet Obstruction
Trauma
Gross Hematuria
Priapism
Emergency cases tend to be large in number low in variability.
…some advantages to the emergency booking environment

10. “B – SOR - E” Materials & Methods
Design and preparation of a booking system.
Ortho (8)
G Surgery (8)
N Surgery (4)
Obstetrics (6)
Vascular (2)
Graphical Data Stream

11. “B – SOR - E” Materials & methods
“Statistical control” through real time data analytics…..
We can continue to operate safely in marginal or
high demand conditions Anaesthesia Monitor
Dashboard 2005 Ford Taurus
Mmmmmmm purple….

12. “B – SOR - E” materials & methods
TableauR
analytics:
Rapid graphical evaluation
•Cluster detection
•Outlier detection
•Rapid trend detection
•Seasonal variation
•Detect “gaming”
Outlier detected
One example of ‘abnormal variance’

13. “B – SOR -E” materials & methods
Data analytics:
3. Insight courtesy of Mahesh Nagarajan Sauder module # 3
Basic process analysis: Variability, Capacity, Flow time
Limited
Capacity
System
Reduce
Input 5%
Increase
flow
35%
Outliers have been removed
Elective cases

14. “B – SOR - E” What did we learn?
Safe Assumption:
‘Some orthopaedic surgeons are faster than others’
 Average time per ER case: 116 min
 Dr. Red 199 170% 268 min.
 Dr. Orange 140
 Dr. Yellow 131
 Dr. Green 99
 Dr. Blue 95
 Dr. Indigo 81
 Dr. Violet 69 59% 56 min.
 Average = 116 minutes
We learned to mix fast and slow surgeons
(reduced variability = improved flow)

15. “B – SOR - E”
Average time taken to perform hip hemi-arthoplasty (minutes)
Average time
= 116 minutes
268 min.

16. “B – SOR - E”
Reducing overall variability by mixing
surgical work types “surgical smoothing”
(mixing fast with slow)
T
(Hrs)
Average time
Hemi A Tibia Femur
What can HA do with the data?

17. “B – SOR - E”
What did we learn?
New Metrics
Case activity : Call ratio
Analytics + Theory = Power to “adjust”
Here’s a practical example……….
Adjustments for procedure time
• (Mix fast surgeons with slow surgeons)
Adjustments for case activity rate
• (Mix more active surgeons with less active surgeons)
Adjustments for weekend / weekday activity
• (Mix more active surgeons with less active surgeons)

18. “B – SOR – E’” (New & Old)
Ready?
1. Implementation phase
2. Funding
3. Consent from IHA-SET
4. Single site pilot