SIP 5 Measuring & Managing OR Capacity/Utilization

1. SIP 5Measuring & Managing OR Capacity/Utilization Peter Buckley, MD Lisa Brandenburg, COO July 5, 2005

2. UWMC Surgical Block

3. Surgical Block • Staffed minutes with RN/CST/CRNA/Anesthesia. • Allocated to Surgical Departments • Department accountable for management of their block • Surgeon accountable to accurately schedule elective cases into block time/ case load to be site appropriate/stay within block, not run over. • Block is time specific, not OR specific. • Subject to some rules- release, closure, etc

4. Block Perspectives • Full Block • “Open” Block • “Surgeon Specific” Block • “Partial” Block

5. Main Operating Room Block

6. Pavilion Block

7. Historical Block Distribution • Block apportioned based on historical utilization of OR (1996) • Block distributed on Surgical Department basis, not surgeon (1996) • Surgical Departments allocate times/block to individual Surgeons • Block time is specific, not OR specific (1999) • Block is Surgical Department specific, not surgeon specific

8. Block Utilization Formula Total Dept. Block minutes used +national TO Total Dept. Block Allocated- release time** ** Block release=dept. relinquish time 5 days before surgical day.

9. Surgical Pavilion with Block Release, May

10. Surgical Pavilion with No Block Release, May

11. Reallocation of Block • 2002 3 month rolling avg. including release >70% • 1999 3 month rolling avg. including release >70% % block release • Attempted every 3 months • UHC comparisons

12. Established Surgeon

13. New Surgeon Start up

14. New Surgeon Start-up

15. CHANGES IN SURGICAL UTILIZATION

16. Impact of Block Release on OR Utilization w/release % release w/o release • Main 72% 9.6% 67.7% • Pavilion 72.6% 11.6% 64.5% • R2 67.7% 15.4% 57.2%

17. Why Block Release • To account for expected and predictable surgeon absences • 4 weeks vacation • 4 weeks meetings • Surgeon usable year 52-8=44 weeks (release 8/52=15.4%) No current agreement and operational limitation of block release

18. What To Do About Block Release • Is Block release used? Elective scheduling before block closure TBA/Red-Urgent/Emergent cases • Change block release rules Predictable absences known well in advance eg. 8-12 weeks “full credit” for advance release-?10 weeks out “Partial credit” ?6 weeks out Released block booked in entirety Study extent to which released block is used. Close down/do not staff unused proportion 4-6 weeks out

19. Other Ways to Measure Utilization

20. UHC Conclusions to Maximize Room Utilization • Match room coverage to demand, particularly on evenings • Empower clinical services to manage their schedules • Do not routinely hold rooms specifically to handle emergency cases • Implement approaches to timely case starts that focus on timely collection of pre-op information and patient logistics • Engineer an efficient turn-around process • Implement daily performance management and reporting

21. Health Care Advisory Board Conclusions to Maximize OR Efficiency • Improve turn-around time • Ensure on-time starts • Rationalizing Pre-operative Testing • Optimize Block scheduling • Achieve same number of hours of elective surgery daily

22. Dollar Value to UWMC of Changes in Utilization (in Contribution Margin) • 5% Increase in Utilization at all Sites: $3M • 5% Decrease in Turnover Time: $415K • 20% Decrease in Turnover Time: $1.7M

23. Discussion Questions • What are we trying to optimize for? • What best practices should we adopt? • How do we look at surgeon efficiency?