Health Care organizations are under immense pressure to maximize efficiencies and revenue whenever possible. No area of care in a health system is immune to these forces. Because perioperative areas contribute 50-75% of hospital revenue and 30-40% of expenses, surgery must run efficiently to maximize revenue. One common area of focus is operating room utilization, i.e., the percentage of available operating room minutes used vs. the number of minutes available.
Typically, utilization can be thought of in two ways:
- Operating Room Utilization: The Actual operating room minutes used during a surgical case(s) divided by the total available minutes.
- Surgeon Block Utilization – Actual operating room minutes used during a case(s) divided by the total allocated amount of surgeon block minutes. Surgeon block time allocation is usually set aside for specific surgeons but can also be defined as a service line or surgeon group practice.
Case Tracking/Timing Events
Accurate utilization statistics depend upon several case-tracking (case-timing) events. Here are a few common events:
- Scheduled Case Start: The Time the case is supposed to start
- Scheduled Case Stop: Anticipated end of the case
- Scheduled Case Duration: Anticipated case duration, including set-up and clean-up time
- Case Start Time: (aka “Wheels in,” “Patient in Room”) Actual beginning of the case
- Case Stop Time: (aka “Wheels out,” “Patient out of Room”) Actual end of the case
- Case Duration: The actual case duration (Case Stop Time – Case Start Time)
Key Performance Indicators (KPIs)
Key Performance Indicators (KPIs) are essential metrics that should be tracked and reported monthly. Targets should be set to ensure best practices and an efficient operating room.
- Prime Time Operating Room Utilization: Utilization during “Prime Time” hours as set by the department. Typical hours could be 7:30 am – 3:30 pm, Monday through Friday. Primary hour utilization is the most commonly referenced benchmark and includes all rooms in that time frame
- Surgeon Block Utilization: Utilization is calculated within each individual or group block. Typically, all allocated blocks fall within the “Prime Time” interval
- First Case On Time Start (FCOTS): Percentage of all first cases of the day that start at or before the scheduled case start time
- Turn Over Time (TOT): Time between the Case Stop of one case until the Case Start of a subsequent case
- Accurate Case Duration: The percentage of cases in which the actual case duration is within 15 minutes of the scheduled case duration
- Subsequent Case On-time: Measures the percentage of subsequent cases with a Case Start time of +/- 15 minutes of the scheduled start time
- Case Add-on Rate: The percentage of cases scheduled after the schedule is finalized the day before, as determined by the department
- Same Day Canceled Case Report: The percentage of cases cancelled on the same day as surgery was scheduled
- Case Delay Average Length and Reasons for the Delay: The average delay for cases started on time. It is essential to track why cases are delayed, and a clear, concise list of reasons should be established so that improvements can be made if trends are present
The KPIs directly impact the operating rooms’ utilization; they should be reported monthly and acted upon if targets are not achieved. Impact Advisors has AI and data capabilities to support this endeavor and clinical expertise to support operational improvements. Improving operating room and block utilization will require a collaborative team effort and constant monitoring of KPIs. Improving utilization is a journey, not a destination.
The Bottom Line
Optimized perioperative services improve patient outcomes, hospital margins, and surgeon satisfaction. Success hinges on establishing a collaborative governance structure, taking a holistic approach to improvement, and working with the right partner…………. Impact Advisors.
Learn more about Impact Advisors’ clinical optimization services and how we’ve delivered value through AI, data, and tech-enabled improvement.
