By Rich Krueger
Today’s high-tech OR has benefited enormously from technological advancements in peer industries.
Bulky CRTs have been replaced with sleek, touch-screen LCDs, incandescent lighting with LEDs and surgical booms are made from lightweight carbon fiber instead of steel. Surfaces are coated with antimicrobial surfaces to lower infections, and the overall design and workflow takes into account the latest understanding of both provider and patient ergonomics.
Yet the planning and management of these ORs still rely on methods used 20 years ago. ORs are both the most expensive and most lucrative locations in many hospitals, so it is crucial that OR block time be optimally allocated to surgeons, practices and departments to maximize throughput and minimize waits, while still leaving enough headroom to fit in emergency cases. Most hospitals manage this, at best, with manual spreadsheets, and at worst, based on historical experience. Applying today’s management science to hospital operations requires data. Many hospitals have only recently computerized, partially as a result of the incentives associated with the American Recovery and Reinvestment Act of 2009.
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The availability of both data and tools has created the opportunity for real innovation in perioperative management. Cloud-based operations planning and management platforms enable health care leaders to transition from being reactive to being proactive in managing the OR, in a way that best utilizes this shared resource while also taking into account the specific institution’s culture and policies. There’s a broad spectrum of how hospitals can manage OR resources, from “federated departments” to “centrally controlled.” In the former, each surgical department or practice is given an allocation of OR block time and is responsible for ensuring they meet target utilizations.
Within the department or practice, they can sub-allocate the blocks in any manner they see fit. As long as departments or practices meet their target utilization, they retain their OR blocks. If they exceed target utilization, they may gain additional blocks, and if they fall below target, they risk losing them. In all scenarios, the department or practice fully plans and manages their allocated OR blocks. Centralized control is the opposite. A hospital OR committee manages all blocks down to the individual surgeon level. The OR committee has full visibility into all block operations, and sets the policy that is used to manage block allocation, as well as evaluate whether or not the OR blocks have been utilized successfully.