As the U.S. continues to combat the relentless coronavirus, one of the biggest decisions looming for hospitals is putting forth a plan on how to handle elective surgeries. To help hospitals during another possible elective surgery shutdown, hospitals need to be prepared for OR recovery. 

Key areas hospitals need to be aware of include properly estimating the backlog and identifying real surgical capacity.

THE PROBLEM

MultiCare, based in Tacoma, Washington, was facing two key challenges along these lines:

Increasing OR access for surgeons. MultiCare schedulers, administrators and department chairs were burdened with reconciling the needs for more OR access and the day-to-day constraints limiting surgeon satisfaction.

Accommodating growth. Leadership also was aware that the prerequisites for attracting new surgeons and accommodating those already hampered with a significant backlog were reaching a tipping point. Leadership needed a scalable, cost-effective solution that would address these challenges, maintain their brand and ensure a strong return on investment.

PROPOSAL

MultiCare turned to health IT vendor LeanTaaS. The company's iQueue for Operating Rooms offered a scalable, cost-effective solution that addressed the multiple capacity and access challenges MultiCare faced, said Dr. Mike Meyer, a cardiothoracic surgeon at MultiCare. The solution, he explained, would:

Increase OR access despite constraints, particularly for new surgeons. LeanTaaS offered the ability to proactively notify surgeons of any unused block time so they could release the time and open it up for other surgeons to request and fill.

Increase surgeon engagement. Provide cloud-based mobile and web tools that provide the surgeons transparency into their utilization and performance metrics. The result would increase their access to the operating rooms, so they could reduce, minimize or eliminate their growing backlog of cases.

"This has not only helped our existing surgeons eliminate their case backlogs, but also has provided ease of access to open time for surgeons who were looking to bring new or more cases to MultiCare."

Dr. Mike Meyer, MultiCare

Provide a more efficient way of managing block time. As with most hospitals, block management across the organization was time-consuming and often a source of surgeon frustration, since the data was difficult to understand and highly retrospective. The solution would provide an easier, real-time, productive way of monitoring block utilization, as well as a far less contentious way of collecting and allocating block time.

MEETING THE CHALLENGE

Working with experts at LeanTaaS, MultiCare executives and physician leadership initially implemented a pilot program to increase capacity and access without building additional operating rooms and to increase transparency and surgeon engagement with the organization.

iQueue for Operating Rooms is being used across MultiCare facilities by OR schedulers, clinic schedulers, perioperative leadership and surgeons. It is a lightweight IT product that easily integrates with the organization's Epic EHR and provides cloud-based access on any browser, whether mobile or web, Meyer described.

"The tools streamlined surgeons' and their offices' abilities to find open time and how open time was advertised, and made it very easy for surgeons to proactively release any block time that might not be needed far enough in advance to where it can be efficiently filled by another surgeon," he said. 

"This has not only helped our existing surgeons eliminate their case backlogs, but also has provided ease of access to open time for surgeons who were looking to bring new or more cases to MultiCare."

MultiCare even has been able to allow its schedulers to work remotely, which would have been previously unheard of due to all of the back-and-forth phone calls and fax communications that needed to go on for each and every case, he added.

"And having on-demand access to a comprehensive set of daily metrics helps us quickly identify trends and address opportunities for improvement," Meyer noted. 

"The tool allows very easy sharing across campuses, improving data transparency and credibility across all stakeholders. Additionally, surgeons receive personalized weekly texts and messages pushed to them showing them their utilization and performance metrics, which helps to facilitate more meaningful conversations."

Further, by providing real-time access to operating room metrics across the organization and with surgeons, the historically challenging, time-consuming and often difficult conversations around an individual's or a group's block utilization have become more productive, Meyer said.

"Rather than penalizing surgeons for their block utilization, we are able to have transparent conversations around collectable time by showing the surgeons their actual utilization and practice patterns through the use of the visualizations and effect immediate change," he added.

Over the past few years, MultiCare has developed a strong relationship with LeanTaaS. The vendor does not just implement the product and walk away. It listens to MultiCare's evolving needs and provides product enhancements for greater visibility into the challenges the healthcare organization faces, Meyer said.

RESULTS

In the two years since implementing the tools, and prior to COVID-19's first wave, MultiCare had experienced a 15.2% increase in case volume and a 12.4% increase in prime-time utilization. Prime-time utilization is important because it indicates that more cases are getting done in the operating rooms during normal business hours with existing resources.

What is also remarkable about these numbers is that these increases occurred within exciting capacity and despite the previous access constraints that MultiCare was experiencing, Meyer noted.

"Blocks are being proactively released, on average, 20 days in advance, versus letting them automatically release just a few days out, giving the hospital more time to efficiently and effectively fill the time," he said. "We also see this figure as a marker of physician engagement and, depending on the time of year, have seen release times as far out as 27 days."

During this time frame, more than 844,000 minutes were released, and 669,000 minutes were requested and filled. Notably, 50% of beneficiaries were surgeons without block time, which dramatically increased the total number of requests and overall share volume. Additionally, there have been 35% fewer exclusively unused blocks, promoting higher OR utilization.

"As a result of all this, we have been able to collaborate across the health system to adopt a system-wide block policy with stretch goals," Meyer added.

ADVICE FOR OTHERS

"Don't be intimidated by the technology," Meyer advised. "Health systems are especially slow to adopt new processes, even when the old ones no longer match the current environment. 

"Also, think about the data from operations the same way clinical data is evaluated," he added. "We're quite comfortable looking at metrics when it comes to quality of care, but shy away from similar operational metrics. There's a great opportunity to use technology to our benefit and significantly decrease the cost of care by gaining efficiencies that are not obvious."

Further, consider what a particular technology offers, he added.

"It should be a lightweight IT lift, and easy to understand and access by every type of user," said Meyer. "It should also provide a single source of credible information for the physicians and administrators, as well as be cloud-based and mobile. 

"And be sure the vendor is genuinely interested in partnering," he added. "There are tough operational problems to solve, and the vendor's expertise is often critical in helping, based on their technology and exposure to other institutions."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.