1. SIP 5 Measuring & Managing OR Capacity/Utilization Peter Buckley, MD Lisa Brandenburg, COO July 5, 2005

2. UWMC Surgical Block

3. Surgical Block  Staffed minutes with RN/CST/CRNA/Anesthesia.  Allocated to Surgical Departments  Department accountable for management of their block  Surgeon accountable to accurately schedule elective cases into block time/ case load to be site appropriate/stay within block, not run over.  Block is time specific, not OR specific.  Subject to some rules- release, closure, etc

4.  Full Block  “Open” Block  “Surgeon Specific” Block  “Partial” Block Block Perspectives

5. Main Operating Room Block

6. Pavilion Block

7. Historical Block Distribution  Block apportioned based on historical utilization of OR (1996)  Block distributed on Surgical Department basis, not surgeon (1996)  Surgical Departments allocate times/block to individual Surgeons  Block time is specific, not OR specific (1999)  Block is Surgical Department specific, not surgeon specific

8. Block Utilization Formula Total Dept. Block minutes used +national TO Total Dept. Block Allocated- release time** ** Block release=dept. relinquish time 5 days before surgical day. Albany Medical Center1 week – full credit Wake Forest University*30 days – full credit Abott NW Hospital2 weeks – full credit Parkland HospitalNot answered * UHC Best Performance

9. Surgical Pavilion with Block Release, May

10. Surgical Pavilion with No Block Release, May

11. Reallocation of Block  2002 3 month rolling avg. including release >70%  1999 3 month rolling avg. including release >70% % block release  Attempted every 3 months  UHC comparisons Block Utilization – Phone Survey of UHC Hospitals TargetActual Albany Medical Center75% Wake Forest University80%70-79% Abott NW HospitalNot Answered Literature Review: Johns Hopkins*85% Northwestern80-85%

12. Established Surgeon

13. New Surgeon Start up

14. New Surgeon Start-up

15. CHANGES IN SURGICAL UTILIZATION Total (%)IP(%)OP(%) 199498335557 (57%)4276 (43%) 2004140306846 (49%)7184 (51%) Mean annual change 2.7%2%6% 2005 (proj.)146286984 (47.5%)7644 (52.5%) Annual Change4.2%2%7.7%

16. Impact of Block Release on OR Utilization w/release % release w/o release  Main72%9.6%67.7%  Pavilion72.6%11.6%64.5%  R267.7%15.4%57.2%

17. Why Block Release  To account for expected and predictable surgeon absences 4 weeks vacation 4 weeks meetings Surgeon usable year 52-8=44 weeks (release 8/52=15.4%) No current agreement and operational limitation of block release

18. What To Do About Block Release  Is Block release used? Elective scheduling before block closure TBA/Red-Urgent/Emergent cases  Change block release rules Predictable absences known well in advance eg. 8-12 weeks “full credit” for advance release-?10 weeks out “Partial credit” ?6 weeks out Released block booked in entirety Study extent to which released block is used. Close down/do not staff unused proportion 4-6 weeks out

19. Other Ways to Measure Utilization Billed Minutes/Staffed Minutes “Raw Surgical Time Utilization” Cut To Closed Minutes/Staffed Minutes Main: 71%52% Pavilion: 53%36% Roosevelt: 55%37%

20. UHC Conclusions to Maximize Room Utilization  Match room coverage to demand, particularly on evenings  Empower clinical services to manage their schedules  Do not routinely hold rooms specifically to handle emergency cases  Implement approaches to timely case starts that focus on timely collection of pre-op information and patient logistics  Engineer an efficient turn-around process  Implement daily performance management and reporting

21. Health Care Advisory Board Conclusions to Maximize OR Efficiency  Improve turn-around time  Ensure on-time starts  Rationalizing Pre-operative Testing  Optimize Block scheduling  Achieve same number of hours of elective surgery daily

22. Dollar Value to UWMC of Changes in Utilization (in Contribution Margin)  5% Increase in Utilization at all Sites: $3M  5% Decrease in Turnover Time: $415K  20% Decrease in Turnover Time: $1.7M

23. Discussion Questions  What are we trying to optimize for?  What best practices should we adopt?  How do we look at surgeon efficiency?