Work by specialists from the USC Viterbi School of Engineering has led to significant improvements in turnover times for operating rooms at three California safety net hospitals, allowing "many more hours of daytime surgery per year."
Because of the success of the program, the work will be expanded to include three more hospitals.
A team from the Viterbi School's Epstein Department of Industrial and Systems Engineering began work in January, 2008 at Childrens Hospital of LA, Riverside County Regional Medical Center and Ventura County Medical Center. "The USC team, along with the nurses and doctors at the hospitals, applied engineering principles such as is done to streamline productivity at Toyota and other efficient organizations," explained researcher David Belson.
According to a September 26, 2008 report on the project made to the study funder, the California HealthCare Foundation, reducing O.R. turnover time was adopted as a goal because "this single metric is easily calculated and can be compared to industry benchmarks."
Turnover time was reduced at all three hospitals, at Childrens Hospital from 34 minutes in November 2007 to 28 in July 2008; from 49 minutes to 39 minutes at Riverside County Regional Medical Center; and from 45 minutes to 34 minutes at Ventura County Medical Center.
"Recommendations are still being implemented and a greater impact is expected," the report states adding that "the 21% average reduction thus far adds many hours of daytime surgery per year for each of the three hospitals studied."
The operational changes made were implemented with cooperation and extensive input from hospital staff. They included, at all three hospitals, efforts to:
- Balance the capacities of the processes, to reduce queuing, particularly between pre-op and the operating rooms.
- Improve communications so that people responsible for patient flow were aware of current patient status, when to move patients and overall performance.
- Develop an accurate published schedule based on past history of surgery and realistic turnover times for all surgeries scheduled in advance.
- Define scheduling rules so as to avoid bottlenecks, such as equipment shortages, and manage housekeeping support.
- Implement checklists to avoid delays due to incomplete paperwork on the day of surgery.
- Implement communications to alert surgeons and anesthesiologists to the time they are needed in the operating room for the next case and when patients are available for interviewing.
- Create a stable staffing level for housekeeping through the workday.
- Implement a report card that lets staff know how they are performing and circulate this information widely as an improvement incentive.
Three other hospitals, including San Francisco General in Northern California and Valley Presbyterian and St Francis Hospital in Southern California are now working with the Viterbi School team.
The kind of conditions observed and changes recommended are exemplified in one section of the report, discussing general factors involved in the problem: