Optimizing changeover in the operating rooms – the Anesthesia view
OR changeover time – is there a balanced incentive model?
In our institution we regularly waist a lot of OR time while changing from patient to patient. Multiple problems arise: communication between surgery and anesthesia. Furthermore incentives for stakeholders to minimize changeover time do not exist. What could be a well balanced set of incentives to optimize patient changeover in the OR? Money would maybe be one in today’s world – but how should we allocate the money? Are there any well established incentive systems at other institutions that proved to work out and minimize OR changeover…
Change over time in the operating rooms is a focus of every hospital in that the potential for decreasing the cycle time of one of the most expensive patient care areas directly contributes to the bottom line. Unfortunately multiple variables contribute to delayed turn over times, and some are more readily addressed than others. The best example I have personally witnessed occurs at the Herzzentrum Leipzig where turn over times between cases average 15 to 20 minutes. The core of their model is an ante-room outside the OR, where patients are placed under a general anesthetic, have their monitoring lines placed and are positioned for surgery on an operating room table while the patient in the OR is being closed. At the conclusion of the case, the previously operated patient exits the room through one door, a quick clean of the room is done, and the new patient enters from the ante-room. All that remains is the prep and drape the patient. This model is clearly dependent on having anesthesia capacity and the support staff to service the ante-room, but it is remarkably efficient. The incentives in this model revolve around that teams don’t go home until the final cases are underway, and team metrics are collected and reported in terms of efficiency. Under performing teams are counseled, shown the standard that’s expected and if unable to perform adequately replaced.
I’d like to add to Ted’s referral to the ante-room design in Leipzig. As a manager of the surgical / OR departments in the past, we worked according to exactly this concept.
What I think is important to add, is that this concept only thrives when the competencies of everyone involved from the anesthesia department are aligned and that -as far as I know- this system only works well in combination with a ‘two-tabel’ system for the anesthesiologists themselves.
And be aware that implementing such a system maybe requires the proper layout of your OR-site i.e. demands a redesign / restructuring of the total OR-site; going in through one door and leave through another door at the opposite site of the OR. Could be quite a threshold, in terms of costs and time.
dedicating an anesthesia room to give appropriate anesthesia prior to bringing the patient to the OR is a key factor in OR efficiency. The incentive is volume of cases, not time. Therefore more case mean more money for everyone. The hospital C suite is your way to negotiate this deal. In hospitals that use a bundle payment system and the anesthesia is part of the bundle, it can be very effective and lucrative. The wheel-in, wheel-out is very tricky and requires a great deal of standardization, which is similar to the Toyota case. But in healthcare it is very unpredictable. Anesthesia should be part of the OR committee and discuss budget with the surgical teams as one unit.