Health Care organizations are under immense pressure to maximize revenue whenever possible. No area of care is immune from these forces. For peri-operative areas, one common focus is operating room utilization, i.e. the percentage of available operating room time used vs the amount of time available.
Typically, utilization can be thought of in two ways:
- Room utilization – Actual room time used during a case(s) divided by total free time for a given room.
- Block utilization – Actual room time used during a case(s) divided by total allocated amount of time for a surgeon. Block time allocation is usually set aside for specific surgeons, but can also be defined for the group they belong to or the surgical service(s) the surgeon is associated with.
Maximized Utilization is dependent upon a number of factors. In order to design the most efficient process, it is important that all involved parties have the same understanding of the components involved. The components of Block scheduling can be grouped into several categories:
- Case Tracking/Timing events
- Utilization Key Performance Indicators (KPI)
- Other Utilization KPI
- KPI Industry Metrics
- Block Scheduling Policy & Rules
- Best Practice Suggestions
Case Tracking/Timing Events
Accurate utilization statistics depend upon several case tracking (case timing) events. Here are a few common events:
- Scheduled Case Start: Time the case is supposed to start.
- Scheduled Case Stop: Anticipated end of the case.
- Scheduled Case Duration: Anticipated duration of the case 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 duration of the case (Case Stop Time – Case Start Time).
OR Room utilization is typically assessed in several different ways:
- Prime Time 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.
- Block Utilization: Utilization that is calculated within each individual block. Typically all allocated blocks fall within the ‘Prime Time’ interval.
Other Utilization KPI
The following KPIs should be monitored as they can have a direct correlation to increased/decreased room utilization:
- First Case On Time Start: Percentage of all first cases of the day that start within +/- five minutes of the scheduled case start time.
- Turn Around Time (TAT): Time between Case Stop of one case until Case Start of a subsequent case.
- Accurate Case Duration Estimate: Percentage of cases in which the actual case duration is within 15 minutes of the scheduled case duration.
- Subsequent Case On-time or Early: Measures the percentage of subsequent cases with a Case Start time that is +/- 15 minutes of the scheduled start time.
KPI Industry Metrics
Block Scheduling Policy and Rules
Acceptable Block Scheduling policies have:
- A description of operating room hours/rooms.
- A description of the scheduling process for normal and ‘off hours.’
- A description of who has privileges to schedule a case.
- Block Scheduling rule/definitions.
- Criteria defining start times and On-time starts.
- Delay classification – delay selection choices and who will record them.
- A bumping policy for emergent/urgent cases.
- A schedule close (lock) time for the next day schedule.
Best Practice Suggestions
Here are a few, typical best practices. This list is by no means exhaustive however.
- Consider using surgeon blocks vs service blocks or group blocks whenever possible.
- Post block utilization scores monthly in an area that surgeons can view.
- Set an initial conservative goal of 70% block utilization with a longer term goal of 75% – 80%.
- Block ~ 80% of open rooms in Prime Time, leaving about 20% open to account for emergent/urgent cases and also to be available for those surgeons who do not yet have block time assigned.
- Set a Prime Time utilization goal of 80%.
To monitor Block/Room utilization a number of reports should be employed no matter which system is in use.
- Block Utilization
- Room Utilization
- First Case On Time Start Percentage
- Subsequent Case On Time Starts
- Block Release
- Case Duration Accuracy
- Canceled Cases Report
- Case Delay Reasons
Improving room/block utilization will require a true team effort and constant monitoring of KPIs.
Improving utilization is a journey, not a destination. Bon Voyage!