5 areas to consider when reopening your operating room

Munaf-Noorani-1With restrictions for elective procedures relaxing, it's important to increase utilization in procedural areas and prepare for the new dependencies that will need to be managed in order to realize that capacity. Every organization will need to assess how to reschedule postponed cases while also scheduling and performing new cases. At the same time, you'll need to be ready for adjusted guidance as the country continues to work through COVID-19.

Strategically modifying your operating room schedules and updating protocols to mitigate patient and staff risk are important as doors reopen and hospitals look to safely bring patients back for surgery.

In this post, I'll cover five areas of opportunity to keep in mind:

  • Identifying strategies for mitigating patient risk
  • Triaging your case backlog
  • Reviewing pre-surgical testing protocols and processes
  • Reassessing your block setup
  • Modifying your definition of success

Considering these key areas should help you get the most from your OR as you phase back into a heavier OR schedule.

Identifying strategies for mitgating patient risk

One of the initial hurdles as operating rooms reopen is the increased guidance and expectations around the safety and cleanliness of the hospital environment. In response, your organization may need to review and incorporate additional strategies to mitigate patient risk associated with elective procedures.

  • Consider if there are COVID-19-specific steps that need to be added to patient risk assessments. For example, will elective surgery patients require a negative COVID-19 test documented in the pre-op checklist?
  • Enable ambulatory surgery centers (ASCs) to complete as many surgeries as possible outside of the primary hospital environment. This may include completing procedures at ASCs that are typically performed in the hospital, which will require building new preference cards in addition to ensuring that the appropriate supplies and equipment are available in the ASC.
  • Consider COVID-19-related workflow adjustments that may impact nursing documentation or reporting and prepare for potential impacts to the patient stay. For example, additional cleaning may increase turnover time or create delays if not accounted for. That may result in a patient spending longer in one area than expected, which may require additional case tracking events for documentation.
  • Consider if at-risk or higher-risk patients require additional protocols. Examples include adequate PPE for staff in pre- and post-surgical areas, additional cleaning that may be required between utilizing pre-op and PACU bays, ICU bed needs, and extended PACU stays.

Triaging your case backlog

Reviewing your existing case backlog is tedious and time-consuming, but it’s necessary to identify the true backlog and which cases should be prioritized for rescheduling.

  • Create a strategy around how procedures will be prioritized. Look at the amount of surgical time available versus the wait list and account for considerations such as patient urgency, destination service lines, procedure length, and procedure revenue. You may also need to include variables such as surgeon and anesthesia time requirements or resource needs as factors for prioritizing surgery.
  • Each case should be reviewed for the impact a further delay will have on surgical outcome as well as surgical risk. This activity may require cooperation and review from surgeons or their staff to account for patient specific needs.
  • An initial analysis can be completed through a review of patient risk scores or identifiers along with procedure complexity. This initial analysis can help surgeons and their staff with clinical review and adjustments, and you may also be able to leverage analytics to automate portions of this review.
  • Consider additional metrics for each case like risk to staff, patient screening results, patient recovery needs/timelines, or if this is a procedure that can be performed in an ASC rather than the hospital.

Reviewing pre-surgical testing protocols and processes

Pre-surgical testing or pre-admission testing (PAT) requirements may be reviewed as part of your case triage process, but it is important to consider specific obstacles that may impact your organization around pre-surgical testing.

  • Is your PAT clinic located at the hospital or a separate location? Limiting trips to the hospital may provide more patient comfort and reduce risk of exposure for the patient and staff.
  • Is an in-person examination required for all PAT visits, or can some visits be partially or completely moved to virtual care?
  • For any required labs, can these be conducted at external sites, and will those sites be able to handle the additional demand?
  • Is COVID-19 testing incorporated as part of your PAT protocol? This may require additional order set edits if these tests need to be added to the provider pre-op order sets or PAT order sets.

Reassessing your block setup

Block assignment and block availability is challenging even in the calmest of times. Preparing to restart elective surgeries will require you to reassess your current block allocation and decide if changes are needed to accommodate for a likely constantly changing atmosphere.

  • Will all the specialty, provider, or provider group-specific blocks that were being utilized pre-COVID-19 be needed in the first wave of rescheduled elective cases?
  • Should scheduling structure switch to a demand and need structure as ORs begin to reopen?
  • Do you need to adjust your block availability for new OR hours?
  • Adjusting your automatic block release and manual block release requirements may give your organization and providers more flexibility for scheduling.
  • With increased utilization of ASCs, should blocks in the hospital OR be reserved for more acute patients?
  • With a greater focus on elective procedure revenue, stacking lower-risk and quicker-turnaround procedures in the same block period should allow for increased efficiency.

Modifying your definition of success

You may have to change the way you evaluate operating room performance and adjust your methodology as guidelines change. Previously you may have focused on first case late starts and cancelled cases, whereas now you may need to focus more heavily on turnover time and case revenue. You may also need to create new metrics like “day of surgery cancellations due to positive COVID-19 test” to track at a more granular level and ensure you stay ahead of as many issues as possible. Utilization will always remain key, but your utilization reporting will need to account for new protocol variances. Beginning elective procedures is a small step toward a new normal; planning and adaptability will continue to be important as we move forward.

If you have any questions about managing your OR utilization or other concerns about strategy or technology during the COVID-19 outbreak, email AskNordic@nordicwi.com for no-cost answers from the most trusted team in healthcare IT consulting.

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Topics: COVID-19, performance improvement

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