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

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 40,000 30,000 20,000

Inpatient Total Outpatient

10,000
0

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 85% 5-7pm 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% 90% 80% 70% 60% 50% 40% 30% 20%

Sept

Oct

Nov

Dec

2008

10%
0% Monday Tuesday Wed Thurs Friday Total
Feb

Jan

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% 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

3 mo avg

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% 85% Percent On Time 80% 70% 65% 60% 50% 40% 30% 24% 28% 21% 22% 20% 21% 25% 25% 24% 24% 25%
720 730

84%

68%

68%

69%

70% 65%

70%

74%

75% 70%

20%
10% 0%

21%

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Month

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 33 30 Minutes 25 20 18 15 10 31 32 35 33

26 24 19 23 23 23 24 24

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 3345 3000 2715 2400 2000 1665 1000 615 285 0 October November 210 Decmeber January February 2205 1860 3390

1860 1275 1215 1020 480

1725 1215 450

3:30-5:30pm

5:30-7:30pm

7:30-11:30pm

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