Scheduling hybrid OR time is a common concern for surgical departments struggling to find a return on investment for the $3-4 million space that typically took years to plan and build. Beyond educating staff on how to use the room so they have confidence using the various technology available, therefore increasing room demand and use, another component is the sheer scheduling element.
This scheduling piece of healthcare has changed dramatically. Henri ‘Rik’ Primo, strategic relationships director of digital health services at Siemens Medical Solutions, recalls in the 1970s when he started working in healthcare IT scheduling, the initial demand was to create an automated system that reduced paperwork and streamlined the process to ensure accuracy and improve workflow. Today, this approach has been taken even further as healthcare evolved to include major healthcare systems, specialized clinics and more expensive technology with limited availability. This is in addition to the different insurance coverage, the limited availability of physicians, especially specialists, and high-demand laboratory testing. “It is immense. It is costly and it is prone to error,” Primo said.
The electronic medical record has provided a scheduling tool to help take the paper-based burden off clinicians, and its mass-implementation was spurred by Meaningful Use policies, which include most healthcare settings, but not ambulatory surgical centers (ASCs). These automated systems vary between vendors, and sometimes leave out some of the much-needed higher-level applications.
As a result, scheduling systems are broken down into two types:
- Enterprise-wide patient scheduling systems (EWPSs), which are macro-level programs designed for large healthcare systems, including integrated delivery networks (IDNs). This helps staff manage insurance plans, patient history reports, physician availability, laboratory scheduling and other elements, which ideally help patients visit the facility once for a variety of needs, instead of multiple times over the series of weeks, to improve patient satisfaction.
- Localized EMRs, commonly displayed in dashboard form, at facilities. This can replace the whiteboard model that facilitates traditionally have used to track laboratory testing times, patient arrival and clinician schedules. By moving this to a digital premise, the information can be easily edited between departments to improve workflow and accuracy.
The question remains – how can we improve scheduling processes for the hybrid OR? Experts say the answer is multi-level, but the short answer is by using both systems. The best way to ensure on-time cases is to manage the continuum of care starting from the time the patient is told they need surgery. This includes patient education, pre-op tests and other steps, in addition to providing the relevant forms and paperwork the day of the procedure. Those appointments can be coordinated at the facility where the surgery will be hosted, but often incorporates outside clinics. Enterprise systems can help organize these different points of care to ensure timeliness the day of surgery.
If the surgery starts on time, consistent interdepartmental scheduling is needed to keep case times on track. This requires the micro-level scheduling, which includes all the patient information provided at the macro level, but also staff, equipment, instrument, laboratory and room availability. “While technology can thus make a big difference in overcoming communication and scheduling challenges, it can also provide a structured record of detailed, real-time data captured from automated workflow, integrated documentation, and surgical case tracking solutions,” explained Jeff Robbins, CEO and President of LiveData. “This ‘big data’ is a treasure trove for OR administrators, providing them with a new, more detailed, comprehensive analytics capability to analyze and optimize OR utilization.”
Next Steps in Scheduling
While developing a micro and macro level of scheduling may be the first step, technology continues to evolve, and experts say two concepts will be the future of OR scheduling: Patient tracking and automation and more advanced patient portals that involve a scheduling component to increase patient engagement and let clinicians focus on patient care, instead of scheduling.
Specific to hybrid ORs, patient tracking and system automation can help limit case delay,” said Robbins. “The technology can track when a patient arrives for surgery, if instruments or other supplies are ready, when the patient enters the OR, when the case starts and ends, and when the patient leaves the room for discharge. Some facilities have implemented a limited extent of the possibilities, but more will be seen in the future, Robbins said.
The patient portals have already had a significant impact on patient involvement, allowing engaged patients to see test results, receive upcoming appointment alerts and other time-saving features, but scheduling is the next step. Primo explained the comprehensive software limits scheduling errors, much like online banking software notices inconsistencies. While they will not be scheduling hybrid OR procedures, technology suggests they will start having more choice in care. “That is, of course, the ultimate service level you can provide to patients. You can empower them to make their own appointments,” said Primo.
Different software on the micro level offer various features, but some include:
- Surgical checklists with integrated time-outs to ensure completion
- Dashboard interface communication systems provide relevant case data on mobile, desktop and wall mounted displays; these can be found in laboratory settings, nurse stations and in the OR.
- Imaging files connected to the case information
- Patient tracking inside the facility the day of the procedure to ensure timeliness
Finding the right combination of software to make hybrid OR scheduling most efficient is different for each facility, but experts say things to keep in mind during this purchasing process are:
- Computers should be doing the heavy lifting – if it technology does not help, it is not properly designed.
- Improving communication outside of the departmental silos will assist in scheduling
- Finding a technology that includes the macro and micro overviews will help manage the process, instead of just segments, to ensure on time cases
- Scheduling software is only as effective as the staff using it – be sure to train them on how and why the technology and procedures were introduced; “Successful perioperative scheduling systems are thus designed with a deep understanding of the surgical process, enabling them to function in the operational management role,” elaborated Robbins.
- Automated and tracking systems offer real-time information to keep patients moving, but making sure staff understand the technology benefits to these systems is paramount.