The “Swing-Room" Experience: Productivity Improvements in Elective Hand and Upper Extremity...
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Transcript of The “Swing-Room" Experience: Productivity Improvements in Elective Hand and Upper Extremity...
The “Swing-Room" Experience: Productivity Improvements in
Elective Hand and Upper Extremity
Surgery at St. Paul’s Hospital.
Dr. Thomas Goetz, MD, FRCSC
Clinical Assistant Professor, UBC
“Swing-Room” Concept Implementation
• Opened January 31, 2008– 1st two years of operations
• Funded by the Lower Mainland Innovation and Integration Fund (LMIIF)
– 3rd year• Funded by Procedural Care Funding
PATIENT FOCUSSED FUNDING
Goals of the “Swing-Room”
• Improve Quality of Care– Safer environment than minor procedure
room– Expand scope of SPR outside of main OR– Decant main OR – Decreased post-op recovery time and post-
op pain• Reduce Wait Times• Cost Savings or Increased Efficiencies
Current Study – Look at performance of swing rooms
• Retrospective audit of data gathered from office and operating room data collected at our institution (St. Paul’s Hospital).
• Analysis of:– O.R. Operations Management Efficiencies:
• Surgeon utilization• Surgical turnover time• Throughput
– Operating room costs• Total and costs/case
– Hand and Upper Extremity Waitlist Reduction
Our Data Set
• Data collected from one SPH Hand and Upper Extremity surgeon
• Pre-SPR– Feb. 2007 – Jan. 2009 (2 years)
• 657 patients over 207 O.R. days
• Post-SPR system– Feb. 2009 – Oct. 2011 (21 months)
• 962 patients over 243 O. R. days– “Swing-Room” Patients
» 320 patients over 46 O.R. days– Main O.R. Patients
» 642 patients over 197 O.R. days
Data Available
– O.R. Times• Scheduled• Pre-op• Setup• Anesthesia • Surgeon• Cleanup• PACU
– Office Times• Date of Consultation• Decision Date
•Patient age, gender•Logged Procedure Codes•Times (start and end times)
Surgeon Utilization
69.4
84.5
74.7
50.0
60.0
70.0
80.0
90.0
100.0
MainO.R.
Before"Swing-Room"
"Swing-Room"
MainO.R.After
"Swing-Room"
% SurgeonUtilization
Surgical Turnover Time
Before the
“Swing-Room”
Main O.R. 53m:25s
After the
“Swing-Room”
Main O.R. 45m:54s
“Swing-Room” 10m:44sIncreased RegionalBlocks?
Throughput
Before the
“Swing-Room”
Main O.R. 3 Cases/Day
After the
“Swing-Room”
Main O.R. 3 Cases/Day
“Swing-Room” 7 Cases/Day
Total Cases per Year (assuming 1.5 OR days/week)
216
0
216
144168
302
0
50
100
150
200
250
300
350
Before "Swing-Room" After "Swing Room"
Main O.R."Swing-Room"Total
28% Increase in case throughput
= 86 Additional Cases
O.R. Variable Cost Differences/Day
Main O.R. “Swing-Room
Cost of Labour
RNs @ 7.5 h/d @ $33/h + 18% relief &
22% benefits=
6 RNs
0.5 PWA
0.5 AA
$2,245.50
4 RNs
0.5 PWA
0.5 AA
$1732.50
Cost of Supplies
(Differences in anesthetic costs, surgical sets and
surgeon preference cards)
Supplies @ $155/case
3 cases/day
$465
Supplies @ $90/case
7 cases/day
$630
Total Variable Cost/Day
$2710.50 $2362.50
Variable Cost/Case
Main O.R. “Swing-Room”
Total Variable Cost/Day
$2710.50 $2362.50
Cases per Day 3 7
Variable Cost per Case
$903.50 $337.50
63% Variable CostSavings per Case
Waitlist Reduction – H & UE
• Prior to “Swing-Room”– Elective wait-times ~36 weeks (range 21-
44 weeks)• Based on difference between surgical decision
date and O.R. booking date
• After “Swing-Room”– Elective Wait-times ~7 weeks (range 6-10)
Simple Waitlist Model
• Assume 1.5 O.R. days/week.– 4 Main O.R. days/month
• 3 cases/day
– 2 Swing-Room days/month• 7 cases/day
• Assume 5 new patients booked per week for surgery.
• Assume patients are interchangeable between O.R. settings.
Waitlist Change over 1 year(starting with 144 on waitlist)At 1 Year:
170 patients
At 1 Year:68 patients
Conclusion
The use of a “Swing-Room” concept can improve OR room productivity and efficiency while decreasing costs/case.
Implementation of a “Swing-Room” concept can be used to decrease waitlists.– Shows how patient focused funding can be used
in a government funded hospital to radically decrease waitlists.
Anesthesia Study
A Study of General Anesthesia and Brachial Plexus Block for Outpatient Upper Limb Surgery
Dr. Seib, Dr. Head, Dr. Schwarz
“Swing-Room” Background
• In 2008, the Providence Health Care Health Authority obtained government funding Capital Payback Fund
• Funding used to:1. Expand the surgical outpatient department
2. Build a “swing-room” operating theatre system.• Two (2) side by side procedure rooms• Perform surgeries under regional anesthetic blocks
which could not otherwise occur outside of the main OR under local anesthetic.
Typical Orthopaedic Hand and Wrist O.R. Slate
1. Osteotomy left small metacarpal with possible joint release (30mins)
2. Left wrist scapho-trapezium-trapezoid fusion (90mins)3. Left wrist arthroscopy with debridement (45mins) 4. Ulnar shortening osteotomy of left wrist for distal
radius malunion (45mins)5. Left EIP TO EPL transfer (60mins)6. Resection soft issue mass dorsum left wrist (60 mins) 7. Right proximal row carpectomy possible
scaphoidectomy and 4 corner partial wrist fusion (90mins)
Operations Management - Definitions
– OR Utilization• % time that OR room occupied with nursing/physician activity
– High percentage utilization reflects decreased room idle time
– Surgeon Utilization• % time that surgeon is in O.R. room doing surgery• Excludes surgeon set-up time (time not recorded)
– Generated from case start and end times
– Analysis of Surgical Turnover Time• Time between the surgical end of a case to the surgical start
of the next case
– Throughput • Case output per day
O.R. Utilization
82.3
75.1
83.1
66.0
70.0
74.0
78.0
82.0
86.0
MainO.R.
Before"Swing-Room"
"Swing-Room"
MainO.R.After
"Swing-Room"
% O.R.Utilization
Extra Reserve Capacity from 2 Room System
Surgical Turnover Time
Before the
“Swing-Room”
Main O.R. 53m:25s
After the
“Swing-Room”
Main O.R. 45m:54s
“Swing-Room” 10m:44s
Negative Turnover Time
Upper Extremity Wait Times
• Prior to the inception of the swing room, wait times for elective upper extremity surgery were slowly increasing over time.
• By January 2009,– Wait time to surgery ~211 days
• Calculated from booking date to date of surgery
Forecasting (Pre-Swing Room)
• Extrapolating this increasing trend line– Wait times would be estimated to increase
to ~250 days by December 2011
Waitlists After “Swing-Room”
• Increased case output in the “Swing-Room” -> caused direct decreases in the senior author’s
waitlist (for “Swing-Room” eligible cases).
Ripple Effects in the Main O.R.
• Implementation of the “Swing-Room”-> Caused off-loading of the Main O.R.
• As a result,– Wait times for cases not suitable for the
“Swing-Room” that had to be done in the Main O.R. also decreased.