The assessment conducted at this medical center revealed the opportunity to increase market share by 17% by strategically positioning the surgery program within targeted services, expanding the geographical region of its targeted patient population, developing the ambulatory surgery program, and improving operational effectiveness.

The First Six Months

This case study was prepared by the OR Director of a suburban Chicago client summarizing the status of implementation teams’ efforts six months after the SMI Group completed its analysis & recommendations. The SMI Group assisted the client during these initial six months of implementation. The client is currently continuing improvement without direct SMI Group involvement.

Oversight Committee

• Membership representing broad range of surgical specialties
• Charter agreed upon by all members
• Monthly meetings to approve work of design teams
• Report outcomes and changes to Department of Surgery

Scheduling Design Team

ACTIONS:

• Reviewed and audited surgery info system
• Developed scheduling protocols
• Identified scheduling trends and associated staffing needs
• Modified first come first serve access plan
• Defined start times for first cases of the day
• Role clarification to improve communication

RESULTS:

• Increased efficiency of IS coordinator for a savings of $2200 per year
• Identified improved staffing plan leading to decreased overtime for a savings of $14,000 per year and increased employee satisfaction to leave work on time.
• Percent of first cases in OR within 5 minutes of schedule improved from 29% to 53%

Pre-Anesthesia Screening Design Team

ACTIONS:

• Created new surgery scheduling form to eliminate error, identify special testing and equipment needs.
• Anesthesia developed screening, testing and evaluation protocol to provide consistency, avoid unnecessary testing and decrease cancellation rate on the day of surgery
• Marketing strategy development
• Chart compilation process redesign

RESULTS:

• Reduced cancellation rate on the day of surgery to 1% in April, saving us from $28,545 a month in lost revenue when OR stays empty. Annual $342,540
• Reduction in amount of PT and PTT testing will reap a savings of $28,400 in unnecessary testing

Patient Flow Design Team

ACTION:

• • Improved aspects of preoperative patient preparation and documentation
  • New process – PACU nurse to visit uni

ts and mentor patient preparation for surgery

• Mapped patient flow through entire process
• Trial of increased support staff in the OR

RESULTS:

• Decreased turnover time from 23 minutes to 12.3 minutes
• Additional time increases available OR time by 2.5 hours a day allowing at least 1 additional case per day
• Increased staff satisfaction-feedback from professional and support staff was very positive

Instrument Processing Design Team

ACTIONS:

• Space issues improved
• Preference cards revised
• Creation of stock cart in OR
• Service level agreement in place between OR and SPD
• Loaner tray policy in place
• Surgical packs moved to OR
• Additional workstation added to SPD
• Vertical storage purchased for instruments

RESULTS:

• Decreased hours of re-shelving by 50%, saving 2.5 hours a day
• Updated preference cards is a win for both staff and surgeon, keeping the circulating nurse in the OR not running for supplies. It also gives us consistency in our standard of care to the patients.
• Savings of $6000 annually from spacing out our trays and packs and the reduction in damage from holes and tears.
• The additional workstation increases efficiency during the peak hours of tray assembly
• Increased efficiency and additional workstation lowered FTE by 0.5
• Vertical storage reduces damage to instruments saving $4200 annually (average of 1 instrument at $350 getting caught and bent in the drawer per month).
• Collaboration with Materials Management has decreased our surgical pack inventory by $6386.