SIP 1

1
SIP 1

• Team Leaders
• Judy Canfield
• Dr. Laurie Amundsen

2
Charter

• Outcome Deliverables
• Document current state process(es)
• Document best industry practices
• Value analysis using LEAN methodology
• Identification of optimal patient flow (patient
  experience)
• Identification of optimal information flow
• Identification of essential variability
• Design future state process(es)
• Develop project plan and timeline
• Identify short and long term projects
• Develop metrics and key indicators
• Short and long term project completion
• Strategy for ongoing Performance Improvement
• Essential Metrics
• Patient ready upon arrival
• All resources ready upon arrival
• Block time utilization
• Planned schedule same as actual schedule

Where the team has focused its efforts due to the
need for integration of all teams for Patient
Preparation and Document Management
3
Condensed Process Map
Core process
4
Key Areas of Improvement

• Scheduling Cases
• Preparing for Surgical Cases
• Accessing Patient Data
• RPI Recommendation
• Case Cart
• Patient Preparation
• Document Management

5
Condensed Process Map
Scheduling Cases Map
6
Scheduling CasesIssues

• Case selection, via PCC, is by procedure name.
• Case selection drives the preference list that is
  chosen for the case.
• SCCA patients decide day ahead for surgery and
  require intense coordination.
• Each team member has different definition for
  surgery time estimate.
• Room scheduling is not standardized- Pavilion and
  Main OR have different rules.
• Cases are moved 24 hours ahead after review by
  charge Anesthesia/Nurse staff for correct room
  assignment.

7
Condensed Process Map
Preparing for Surgical Case Map
8
Preparing for Surgical Case Issues

• All systems are manual, which is resource- and
  labor-intensive.
• Preference lists/ pick tickets are not frequently
  reviewed the day ahead, resulting in the wrong
  case cart.
• There is no standard for how information is
  received, reviewed and actions taken.
• PCCs are located in multiple sites.
• Getting the patient access to essential services
  in surgical preparation is difficult.
• Anesthesia bypass process of the surgical patient
  is complicated and inconsistent.

9
Condensed Process Map
Accessing Patient Data
10
Accessing Patient DataIssues

• Information received from outside referral does
  not always make it to the chart.
• All document elements for the pre-surgical
  patient are not accessible to the requisite and
  appropriate staff.
• Yellow packet travels across sites, and is only
  accessible to the site where it currently
  resides.
• Records are lost causing case delays and errors.
• Document completion is not standardized across
  surgical clinics.

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RPI Case Carts
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Past and Current Activities

• Completed PCC ESI training
• Reviewed and evaluated best practice scheduling
  process from other academic medical centers
• Reviewed literature
• Created website for open and released block time
• Established concepts for a best practice
  scheduling process
• Developed Best Practice scheduling process vision
  (includes inpatient)
• Established shared definitions
• Developed standard physician worksheet
• Created criteria/guidelines for scheduling TBA
  cases
• Flexible scheduling process for cases that need
  24 hour turnaround of schedule (i.e., cancer,
  orthopedic injuries)

13
Best Practice Scheduling Process Recommendation
Process for scheduling is standard for both
inpatient and outpatient cases by the PCC
Patient and Physician determination of surgical
procedure
Standard Worksheet completed essential elements
MD determines and is accountable for procedure
name, duration and preference list from data
sheet with his/her specific cases and PLs
Information is entered into ESI and scheduled by
PCC
Cases are scheduled to accommodate patient
preferences and special needs
Scheduler acknowledges work submitted
PCC places case in block time
If no block is open
48 hours before day of surgery charge personnel
checks surgery schedule for fit, moves TBA cases
into open block and communicates these to services
PCC reviews web site for released time
If no released time available
PCC places case in TBA schedule
14
Key Reality Checks
Next Steps

• Develop future metrics
• Develop implementation plan for new scheduling
  process
• Develop plan for elements not discussed (due to
  time constraints) but of importance

• Will this make our scheduling process easier? 
• Will it flow better and have more accuracy? 
• Does our process give feedback to those using it?

15
SIP1 Team
16
Appendix
17
Comments/Questions from OR staff and department
road shows

• Patients have lots of history but we cannot
  get/retrieve the record.
• PCCs have a lack of training in choosing the
  right PLs. Do we as the OR need to embrace
  training and collaborate with the PCCs?
• Because of the acuity of our patients, the day
  before the appointment in the Pre-Anesthesia
  Clinic is not enough lead time to prepare for the
  patient.
• Inpatients should be seen by the Pre-Anesthesia
  Clinic also.
• We are still getting incomplete instrument sets
  and wrong items in the case carts.
• Continuity of preop evaluation and on-site
  anesthesia management.
• Crisp definitions of time that make sense to the
  surgeons.

18
Review and Evaluation of Other Scheduling
Practices
Please note that this is only a small portion of
the informal survey
19
Literature Review Sample

• Schedule the Short Procedure First to Improve OR
  Efficiency Lebowitz, Phillip, MD, Oct 2003
• What makes a well-oiled scheduling system? OR
  Manager
• Determining Optimum Operating Room Utilization
  Tyler, D et al., 2003
• How to schedule elective surgical cases into
  specific operating rooms to maximize the
  efficiency of use of operating room time Dexter
  and Traub, 2002
• Optimal Sequencing of Urgent Surgical Cases,
  Dexter et al., May 1999
• Creating an Optimal Operating Room Schedule,
  Calichman, Murray, May 2005
• Applications of Queuing Theory, Vanaswala and
  Desser, Feb 2005
• Improving Operating Room Coordination, Moss and
  Xiao, 2004