OPERATING ROOM DASHBOARDVirginia Chard, RN, BSN, CNOR

Pen Bay Medical Center Rockport, ME

Today’s Healthcare Challenges

It’s a new day in how we deliver and how we are paid for delivering patient care.

Healthcare reform has brought new strategies, processes, and innovations to the table.

• Affordable Care Act• Accountable Care organizations • Meaningful Use • Value Based Purchasing

New emphasis going into the future:• Quality • Performance • Accountability • Efficiency

What this means for the Us

• New strategies for efficiency, cost containment, revenue enhancement

• New funding- pay for performance, bundling • Improved utilization of space, time, human

resources

Strategic Plan

Our overall mission: • Offer safe, highest quality patient care and

customer service to our community • Increase patient, surgeon, staff, and

anesthesia engagement and satisfaction • Create potential for new business

opportunities

The Journey

• Engaging the executive Team in our plans and expected outcomes

• Defining the key stakeholders and their roles in the process • Identifying needed resources (i.e. IT) to support the data

gathering • Developing a format to present the data in a consistent,

concise package • Building communication channels to share our data and

move our goals forward as a team

Who owns this journey?

Identify Stakeholders: • Executive team members• Medical Director • Chief of Surgery • Chief of Anesthesia • Surgical Director • Department Managers-OR/SPD, PREP, Surgical

Care • Front line staff

Facts of data management

• Most health care facilities and operating rooms maintain databases and generate dashboards that help the management evaluate its performance; Multiple genre of data has been collected in perioperative service:– Clinical outcome: e.g. Surgical Care Improvement Project

(SCIP) measures– Institutional initiatives: e.g. patient satisfaction rate– Risk management data: e.g. medication errors– Operational efficiency: e.g. first case on-time start– Financial performance: e.g. supply cost/ case

The Game Plan

• Assessment of where we are • Team Collaboration across all disciplines• Education and Communication • Stakeholder ownership and involvement • Development of key performance indicators • Process changes identified • Implementation of identified changes • Sustainability

Where We are

Stakeholder Participation

Education/Communication

Ownership/Involvement

Key Performance Indicators

• Monitor and improve turn around times • Monitor and improve first case start times • Monitor and improve/right size block

utilization • Monitor and improve booking accuracy

The Surgical Dashboard• Why

– To report surgeons’ operational and financial performance– To maximize block utilization

• How– Retrieve data from ORIS, preference card, supply chain master item file to

generate the comprehensive report• What

– Surgeon scorecards satisfy the needs of block management and present the complete picture of surgeon performance related to OR operations

– Key Performance Indicators are in line with OR performance dashboard, e.g. case volume, first case on time start

– Block utilization, out-of-block surgery minutes• When

– Monthly report for review and report– Quarterly report for OR leadership’s decision on block reallocation

Data Management Challenges in OR:

• Data accuracy

– Many ORIS do not provide data-cleansing functionality - “Garbage in garbage out”

– Accurate, complete data is essential to an effective performance dashboard

• Analytical skills and experiences in OR data management

– DRIP – Data Rich Information Poor

– Let the numbers speak, “gut-feeling” is not always right

• Buy-in of surgeons and clinicians– Data and information needs to be presented in an intuitive and informative manner

– Increase data transparency and data sharing with clinicians

• Culture change– It takes time for data-driven decision making to Gain Ground in hospital and

perioperative management

The Tools

PBMC Surgeon Utilization Report

PBMC Surgeon Utilization ReportReserved Block Minutes Use

PBMC Surgeon Utilization Report•Minutes in Regular Hours•Estimated vs. Actual Minutes•First Come, First Served Minutes

PBMC Surgeon Utilization Report•Day Surgery•Emergency Minutes In/Not In Regular Hrs

Dashboard detail –specialty group block time

First Case Start Time

First case start is defined as the time the first scheduled patient of the day enters the OR

On time is defined as patient in the room by 0735 or within 5 minutes of scheduled start time

Detail

First Case Starts

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

>30 min21-30 min11-20 min6-10 minon time

Turn Around Times

Definition of Turn Around Time: Patient out of the room time to patient into the

room time

Turn Around Times

October November December January February March April May June July August September 0

5

10

15

20

25

30

Series145 min60 min 120 min

OUTCOMES

– A centralized standard report depicting a complete picture of OR operational performance

– A continuous measurement mechanism demonstrating performance trend

– An effective tool helping identify performance improvement opportunities

– An intuitive communication venue facilitating decision making process

The rest of the story

Turn Around Time – • Initial average 27 minutes • Current Average 22 minutes First Case Starts- • Initial performance average- 62% • Current performance average- 81% Results achieved by collaborative changes in

processes by surgeons, surgical staff and Anesthesia

Block Utilization

Work is ongoing as we develop communication

mechanisms to keep surgeons informed of OR utilization and their individual performance within their blocks

Several successful changes have already been implemented to support block utilization and efficiency

Questions???