Electronic Health Reporter

By Ashley Walsh, senior director of client services, LeanTaaS.

Elective surgeries were hit hard during the initial onset of the COVID-19 pandemic. In fact, 70% of elective surgeries in the country were put on hold to free up staff and resources to care for those infected with the virus. While putting elective surgeries on hold was a necessary precaution as most facilities navigated the uncertainty, patients with scheduled procedures had their care disrupted.

Now, as multiple waves continue to afflict the country and as we head into the flu season, hospitals have been actively seeking ways to build agility into their operating room capacity and better handle the elective case fluctuations.

Operating rooms are the economic backbone of a hospital, frequently generating 50% or more revenue for the institution. In fact, a single block of operating room time can generate $50K to $100K or more in net revenue per day, so when it comes to allocating time, every minute is sacred. Despite the unknowns, hospitals that are able to manage optimal surgical capacity despite the volume reductions followed by an influx of backlogged elective cases by having access to the right information and by adapting strategies that make the strongest impact. Let’s dive in.

Get ahead of seasonal and potential patient volume fluctuations

As a first step, providers should ensure that surgical case information is available that illustrates how many elective surgeries had to be pushed or rescheduled as well as how they have historically done during the flu season. The combination of this information will help predict the upcoming winter.

Although there are online tools available to pull these insights, it’s also important to lean on the skills of data science teams to help analyze this vital information. Here are a few important data points providers should have on file to make informed decisions during these uncertain times:

• baseline monthly surgery volume before COVID-19 and the percentage of baseline cases during the pandemic;
• the volume of new cases that you anticipate based on COVID-19 (e.g., surgeries resulting from car accidents have likely decreased because of fewer cars on the road);
• the volume of cases you expect to lose based on people losing their jobs and/or health insurance; and
• historical seasonal fluctuations, particularly during flu season.

Calculate actual surgical capacity

Once you have the project stats on hand, the next step is to consider potential constraints in terms of staffing and available beds in order to calculate true surgical capacity. While doing so, it’s important to consider potential options and workarounds that may be available to expand capacity, whether that be opening up additional operating rooms, staying open for longer hours, having weekend hours and/or even redirecting some procedures to other types of rooms, when possible.

The way in which operating room blocks are allocated by day of week, and by surgeon or service line, will determine how many surgeries of each type will likely be done on a given day and also how much potential bed demand will be placed on various hospital units.

Other factors that could impact efficiency include the volume and timing of add-on surgeries, inflow from the emergency department, or even patients coming in for scheduled inpatient procedures, or acutely ill patients who come in for an outpatient clinic visit and then need to be admitted.

When thinking about what other types of adjustments can be made to increase efficiency during these uncertain times, it’s important to consider staffing models, from the surgeons and nurses to the anesthesiology, support and supply teams. Once the staffing plan is under control, providers also need to factor in bed availability, which includes taking into consideration the number of overflow beds, or if patients can be transferred to other facilities as they recover, to free up some space.

Closely monitor metrics – of all kinds – with particular attention on predictive and prescriptive metrics

While most providers are monitoring and updating key metrics each day, it’s also critical to analyze volume and identify potential backlog issues periodically to estimate progress. To support capacity decision making, it is also important to make data available and transparent across all departments and with the surgeons, too. This transparency will help garner support for some give and take negotiations around OR access as well as the “all in this together mindset,” while ensuring care teams are aligned.

Levering readily accessible technologies enables ORs to automatically provide surgeons with a digital summary of their operating room activity so surgeons can better understand how they are contributing to operating room volume, how their performance measures are trending, opportunities to improve their utilization and even recurring causes of delays.

In 2020, we are able to move past the “retrospective dashboard” mindset and can give hospitals the self-service capability to access the important data, and predictions, in real time. This level of data has shown to have clear and demonstrable outcomes on capacity utilization, surgeon satisfaction, and on financial performance.

Looking ahead

Currently, 15% to 25% of cases are done outside of block time while 10% to 15% of block time goes underutilized or abandoned in many hospitals. Often cases performed outside of block time are performed “after hours”, as add-on cases, due to access constraints. These add-on cases can contribute to overtime, dissatisfaction and even impact quality of care. Fortunately, many hospitals have begun to use predictive analytical tools to address the problem and are achieving positive results.

For example, algorithms are being deployed to monitor booking patterns that identify underutilized blocks that will alert surgeons and their offices so that the surgeons/offices can proactively release the time into an open pool available surgeons can use. This best practice facilitates the release of block time well in advance of the block release deadline, which greatly increases the likelihood of other surgeons being able to see, pick up, and use that time.

This best practice also increases surgeon satisfaction, particularly for surgeons who are seeking to grow their practice and/or bring more cases to the hospital.

Unfortunately, the future/ongoing impact of COVID-19 and/or the impact of the impending flu season is still truly unknown. To date, as social distancing restrictions ease across the country, we have experienced an uptick in cases in many states and a lock down of elective cases. The most important thing that surgical facilities can do now is to build agility into capacity management. Thankfully, there are resources available that your hospital can adopt, execute, and adapt as needed.

We are in this together and we are committed to helping health systems build agility in to the capacity management of their most expensive assets now and in the future.