Top 10 OR Dashboard Metrics Pamela Ereckson Fox, MD OR Dashboard Metrics • Volume – Case Volume – Case Minutes – Case Minutes by Time of the Day • Utilization – OR Utilization by Day of Week – Block Utilization 2 OR Dashboard Metrics • Operational Stats – Turnover Time – On Time Starts – Cancellations – Add Ons – Overtime Minutes Case Volume • Reflects total number of cases over time • Compares inpatient to outpatient volumes • Allows you to follow growth as well as seasonal variation – The following sample hospital has a decrease in volume in August which reflects a time when many surgeons take vacation • Average number of cases per OR per year in best practice ORs – Inpatient 900 cases per OR/year – Outpatient 1400 cases per OR/year Surgical Case Volume Trend 700 600 500 Oupatient 400 300 200 100 0 Inpatient Total Case Minutes • Reflects total number of minutes of surgery per month. • Also reflects growth as well as seasonal variation • Comparison between volume and minutes helps in determining growth patterns – Increase in volume with a small increase in minutes usually means a growth in smaller cases usually outpatient – Small increase in volume with a larger increase in minutes usually means a growth in longer cases usually inpatient Surgical Case Minutes Trend 70,000 60,000 50,000 Outpatient 40,000 30,000 20,000 10,000 0 Inpatient Total Case Minutes by Hour of the Day • Allows you to look at what percentage of case minutes are completed in each shift • Goals – 90% of minutes completed between 7am-3pm – 95% of minutes completed by 5pm • Following sample hospital graph shows a process improvement project that started in June at 84% completion by 3pm with increase of completion to 90% over 6 months. Processes addressed were • Start time • TOT • Revision of block schedule • Staffing levels Case Minutes by Hour of the Day 100% 95% 90% 11pm-7am 7pm-11pm 5-7pm 85% 3-5pm 7-3pm 80% 75% June July August Sept Oct Nov Dec Jan Feb OR Utilization by Day of the Week • Reflects total OR utilization on each day of the week • The goal is to even out the utilization so there is little variation between the days of the week • Goal in best practice ORs is 75%-80% total OR utilization. This allows adequate “flex” in the system • The following sample hospital revised its block schedule to allow better utilization of Thursdays and Fridays OR Utilization by Day of the Week Goal >75% August 100% Sept 90% 80% Oct 70% 60% Nov 50% Dec 40% 30% 2008 20% 10% Jan 0% Monday Tuesday Wed Thurs Friday Total Feb Block Utilization • Block utilization is calculated by surgeon/service • It is best to use adjusted utilization in order to not penalize a surgeon for TOT – Adjusted Utilization= total block minutes utilized +TOT/ total block minutes available • Goal is 75% block utilization in order to maintain block. When decreasing blocks according to utilization you should decrease by days of the month not hours of the day – Example: A surgeon w/ 50% utilization of a block on Monday would have the block reduced to either the 1,3,5 Monday of the month of the 2,4 Monday Block Utilization Average Block Utilization by Surgeon Goal = 75% Recent 3 Mo Recent 6 Mo 100% 90% 80% 70% 3 mo avg 60% 50% 40% 30% 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 13 OR Start Times • Defined as time patient enters the operating room • Usually monitored at exact time and within 10 minutes – Example: 0720 exact time while also monitoring the 10 minutes later at 0730 • Goal is 90% within 10 minutes • Sample hospital on next slide reflects a PI project that improved start time from 65% to 85%. Issues addressed were – Communication between team members – Monitoring of start times – Communication to surgeons the importance of on time starts by the OR committee – Change in Preoperative Patient preparation OR Start Times Goal >90% 90% Percent On Time 85% 80% 70% 65% 68% 68% 69% 70% 70% 74% 84% 75% 70% 65% 60% 50% 720 40% 730 30% 20% 24% 28% 21% 22% 20% 21% 25% 21% 25% 24% 24% 10% 0% Feb Mar Apr May June July Aug Month Sept Oct Nov Dec Jan 25% Average Turnover Time • Turnover time is calculated as patient out of the room to next patient in the room • We usually follow same surgeon turnovers since there is quite a bit of variability when turning over between 2 different surgeons or services • Goals – Outpatient 10-20 minutes – Inpatient 30-40 minutes • Sample hospital slide shows a PI project that begin in April. Issues addressed included – Staffing Levels – Communication between team members – Preoperative patient workup Average TOT Average OR Turnover Time IP 30-40 min, OP 10-20min 40 35 35 33 31 Minutes 30 33 32 26 25 24 20 23 23 23 24 24 19 18 15 10 5 0 Jan Feb March April May June July Month Aug Sept Oct Nov Dec Jan Feb Overtime Staffing Minutes • Reflects amount of overtime minutes paid to OR staff • Sample hospital PI project decreased overtime minutes significantly over a 4 month period by addressing – On time starts – TOT – Staffing levels by time of the day – Block Scheduling • Gaps in schedule • Overbooking. – Example: A surgeon with an 8 hour block routinely runs 10 hours. The block should be adjusted to 10 hours and staffing levels changed to meet this need Overtime Minutes 5000 4680 4350 4000 3390 3345 3000 2715 2400 2205 1860 2000 1665 1860 1275 1000 615 285 1215 1020 1215 480 450 210 0 October 1725 November 3:30-5:30pm Decmeber 5:30-7:30pm January 7:30-11:30pm February Total Cancellations • Usually monitor same day cancellations • Factors that impact cancellations – Preoperative preparation including preanesthesia testing and patient education • Sample hospital slide shows a PI project for preoperative preparation that included a pre-anesthesia testing clinic, that provided not only testing but patient education and financial counceling/insurance verification • Goals – <1% for an outpatient setting – <10% for a major trauma center % Cancellations Goal <1% 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% Sep Oct Nov Dec Jan Feb Mar Apr May June Jul '08 '08 '08 '08 '09 '09 '09 '09 '09 '09 '09 % Cancellations Add Ons • Reflects adequate open/urgent time – Open time is time available to anyone and can be booked in advance. This accommodates the non-blocked surgeons – Urgent time is time available starting 24 hours before. This accommodates many cases that need to be done urgently but are not emergent. Many general surgery and urgent ortho cases fit into this category • Goal < 20% % Add Ons Goal < 20% 30% 25% 20% 15% % Add Ons 10% 5% 0% July August Sept Oct Nov Dec Jan Feb