7 Ways to Scrub Inefficiency From the O.R.

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October 1, 2013 Volume 77, Number 10
7 Ways to Scrub Inefficiency From the O.R. Adam L. Blomberg, M.D.

Since the O.R. is responsible for as much as 60 percent of hospital revenues, canceled or delayed procedures can deal a blow to a hospital’s bottom line, as well as dramatically decrease patient satisfaction. Being able to reduce turnover time and increase efficiency in the O.R. means that not only are hospitals able to maximize surgical time, but patients are able to have a streamlined, satisfying experience. Efficiency begins with the “traffic cops” of the O.R. – the anesthesia department. Here are seven ways the anesthesia department can champion scrubbing inefficiency from the O.R.


1. Utilize a patient-centered approach to preoperative testing. Efficiency begins outside the O.R., when surgeons order preoperative testing for patients. Plenty of surgeons still believe that extensive testing is necessary, but this school of thought can be harmful to patients by producing false positives that can delay a procedure. Instead, preoperative testing requires evaluation on a patient-by-patient basis. By communicating with the surgeon and the patient’s primary care physician, anesthesiologists can help formulate a preoperative testing plan suited to the patient, eliminating unnecessary testing, reducing costs, and ultimately helping to prevent canceled or delayed procedures.


2. Conduct advance review of patient data and test results. Stemming inefficiencies means knowing what to expect. By completing preoperative testing at least one day in advance of elective surgeries and reviewing the results, anesthesiology departments and the surgical team are able to clear their patients for surgery. Additionally, the anesthesiologist is able to review the patient’s chart and prepare the proper anesthetic for the procedure.


3. Approach communication as a three-way street. It sounds simplistic, but the best way to eliminate inefficiency is to communicate with the surgical team and the patient. This means that anesthesiologists will know when the surgery is scheduled and how long it will take. It also means that the recovery room will be ready to receive the patient, and that the preoperative team is preparing the next patient for surgery. Anesthesiologists can also communicate with patients so they know what to expect. For example, most patients may think they can’t eat anything after midnight before a surgery, but if the procedure is scheduled for later in the day, they can eat breakfast in accordance with standard NPO guidelines. They also need to know what to expect with their anesthesia and where to check in, among other things. Patients who are well-informed are ready for their procedures.


4. Utilize block scheduling for surgeries. There is no good reason for a hospital to purposely schedule all surgeries at 7:30 a.m. and then have empty O.R.s throughout the day. By consolidating the O.R. schedules into vertical blocks, both O.R. and surgical team time is maximized, preventing the possibility that patients will be waiting for their procedure while surgeons finish a previous operation.


5. Relocate the recovery room. If the patient has to be wheeled from the preoperative area downstairs to the O.R. upstairs, then to a recovery room clear on the other side of the hospital, the configuration itself represents a huge inefficiency. This inefficiency can easily be eliminated by relocating the preoperative area and recovery rooms closer to the O.R.s. Reconfiguring the hospital can save time in both patient transportation and the time it takes for surgical staff to move from room to room. Hospital administrators may hesitate, but a smoother patient flow increases patient satisfaction, staff morale and overall efficiency.


6. Create standards for anesthesia and surgical care. Applying a patient-centric approach doesn’t mean that some things can’t be standardized. By following the latest news in evidence-based medicine, the anesthesiology department can choose the types of anesthesia it will normally use regionally or generally, as well as standardize postoperative and intraoperative pain care. This can include quality of anesthetics as well as how they’re administered, which creates a consistent experience for patients and surgeons alike.


7. Share best practices across departments. The most inefficient way to run an O.R. is to exist in silos, where anesthesiology does things one way, the surgeons do it another way, the schedulers still are operating on their own timetables and no one communicates. Assemble task forces to share best practices for materials, efficiency, holding areas, pre-admissions testing and communications. Populate the task forces with members of all affected departments and agree on a set of best practices to use for each. Once those best practices are in place, continue to revisit and refine them, ensuring that the standards set by the members of the task force adapt to changes in medicine, patient care and technology.


Ultimately, communication is the common thread that runs through each of these tips to improve efficiency in the anesthesia department and beyond. While anesthesiology departments in and of themselves can run efficiently, it means nothing if the rest of the surgical team isn’t able to benefit. By communicating procedures to the staff, surgeons and patients, anesthesiologists can play a key role in ensuring patient satisfaction in and out of the O.R., as well as contributing to the hospital’s bottom line.

Adam L. Blomberg is the National Education Director of the Anesthesiology Division of Sheridan Healthcare, Inc., Sunrise, Florida.