Back to basics: efficiency is not rocket science

1. Implement a surgical pathway and keep single source of truth for each professional to improve visibility and collaboration

1. A clinical pathway, comprehensive enough to cover pre, intra and post OR tasks.
2. A single source of truth, changing dynamically based on the clinical pathway.

• Create a multidisciplinary care plan for surgery. You can start easy by building a generic care plan for surgery (ambulatory vs programmed) and then specify per pathology or procedure.
• Have full and real time visibility of patient progress on the care plan.
• Make sure that the software used to follow the care plan communicates with other systems in use and is automatically updated as new data is available.

2. Stratify patients to avoid cancellations due to unexpected clinical conditions

• Documentation of the condition(s) for which surgery is needed;
• Uncovering of hidden conditions that could cause problems both during and after surgery;
• Perioperative risk determination;
• And optimization of the patient’s medical condition in order to reduce the patient’s surgical and anesthetic perioperative morbidity or mortality.

• Include eligibility criteria and exclusion criteria in your surgical clinical pathways;
• Use risk stratification scores and validated questionnaires;
• Anticipate the perioperative stratification to make sure that our teams have the information needed to decide timely;
• Create clear decision criteria for a go-decision for surgery, including who needs be informed.

3. Automate repetitive tasks to free surgeons and anesthetists’ time

1. Patient assessment and stratification before surgery, improving seamless patient navigation and reducing last minute cancellations due to clinical reasons.
2. Patient follow-up after surgery increasing patient safety and physicians’ confidence on early discharges.

• Use an omnichannel approach (SMS/Voice/Web) to automatically collect patient data before appointments/surgery.
• Stratify patients automatically, using validated questionnaires and EHR interoperability capabilities able to interpret the information received.
• Provide your teams with the information in an actionable way, meaning they can fast track low risk patients for surgery and invest their time and knowledge on complex patients.
• Use your EHR interoperability capabilities to automate pre-surgery exams prescription and automatically generate medical records.
• Use the same communication engine to follow-up patients after surgery to prevent rehospitalization without increasing teams’ workload.

4. Empower patients and promote evidence-informed behaviors

• Provide patients with information adapted to their health literacy level, about the disease and perioperative journey.
• Make sure they know how to navigate care – what to do – every step of the way.
• Keep regular points of contact to increase their confidence on self-management.
• Provide them an intuitive and fast channel to report any red flag, increasing the perception of close monitoring by health teams.

5. Build a continuous improvement culture through a lean management system

• Standardize collaterals processes such as sterile processing and inventory, labs, and scheduling.
• Standardize workflows for setup time, instrument flow, and post-operative transfer.
• Constantly monitor and analyze bottlenecks, to demonstrate the problem and convince people that the solution chosen in the right one.

Takeaways:

• Maximizing operating room efficiency has important implications for cost savings, patient satisfaction, and medical team productivity.
• Although time consuming, process mapping of each step of the patient journey from pre-operative visit to post-operative discharge have multiple benefits related to costs reduction and quality improvement.
• Enhanced collaboration of multiple professionals and care levels, patient stratification and automation arise as key points to increase capacity.