What is the Operating Room Optimization Initiative?
The Central Zone is leading an Operating Room (OR) Optimization Initiative that aims to optimize how operating rooms and other perioperative areas, are utilized, by helping identify and test out ideas being suggested by staff, physicians and teams.
The initiative builds on past efforts to support improved efficiency, with a focus on making quick, iterative improvements that hopefully will yield immediate results in terms of efficiency and utilization.
The initiative will also help develop medium and long-term tactics that will create a sustainable model for Central Zone operating rooms and support the teams doing this work.
The initiative is being overseen by the Central Zone Executive Action Team and an Operations Panel has also been identified to help advance this work. The group will collect and review information and forward recommendations for review and approval. (See team lists below).
The OR Operating Room Efficiency Initiative is an important part of Nova Scotia Health's overall Surgical Access and Quality Improvement Strategy and government's Action for Health plan, which aim to increase surgical volumes to address surgical and endoscopy backlogs, achieve more manageable
Activity to Date - December 2024
OR Optimization - Phase I
Phase I of the OR Optimization work began as a focused 5-month improvement effort undertaken across Central Zone to accelerate in-flight work and drive impact on the following three objective:
- Improve Efficiency: Improve turnover times, enhance scheduling practices and optimize the staffing model.
- Improve Utilization: Increase volume of procedures performed to support the reduction of the surgical backlog.
- Enable Sustainability: Support lasting change through effective implementation and change management.
The diagnostic phase kicked off late March when leaders; supported by consultants, began visiting perioperative sites at QEII, Dartmouth General Hospital and Hants Community Hospital to:
-
observe the flow of patients throughout their surgical experience, meet with local teams, including front line staff and physicians, to hear their thoughts on barriers to efficiency they have observed / encountered and to invite their ideas on improvement ideas.
A team from Nova Scotia visited Humber River Health in April, to learn about some of the approaches and technologies they are using to increase surgical volumes. The busy, highly-digitized community hospital has more than two dozen ORs and has successfully implemented work flows to support high efficiency / high throughput surgery, with a focus on joint replacements.
Based on site visits, data analysis, input from our teams and consideration of past efficiency work, seven change ideas were tested to optimize efficiency and utilization
Information and updates on the seven initial areas of focus can be found below. Each highlights the challenge identified, the solution implemented or tested, early impacts and next steps.
- Proceed with surgeries as scheduled, even if an inpatient bed is not confirmed, within specified criteria
- Schedule a waitlist OR short elective case prior to day of surgery as the first case of the day in waitlist rooms
- Book elective patients 2/4 weeks in advance, at minimum
- Establish a clear set of guidelines on OR ‘give backs’ with accountability mechanism
- Implement a CZ perioperative performance review process
- Reduce OR turnover times
- Smooth demand for PACU and admissions by scheduling shorter and/or outpatient cases as the first case in some blocks.
Additional information related to these initiatives is also been shared with teams, including updates and standardized operating procedures (SOPs). These documents can be found below.
Remaining Opportunities: Many additional improvement opportunities were identified through the diagnostic process. As part of the ‘path forward,’ these change ideas have been included as further considerations.
OR Optimization - Phase II
Coming out of the busy summer vacation period, perioperative physicians and staff expressed a renewed commitment to improving OR efficiency and utilization.
Momentum has been generated through the initial phase of this work, so while changes have been incremental, they have established trust and built the foundation for continued improvement. To sustain efficiency gains and increase impact, larger scale changes are needed. The path forward set out on can deliver significant value to perioperative staff and patients.
To sustain the momentum built to date and to continue to improve perioperative efficiency, Central Zone will work to sustain implemented changes, monitor results, identify refinements and new change ideas. We will also begin to transition focus to two high-impact, large scale opportunities:
Right Case, Right Site: Increase outpatient site utilization by migrating appropriate lower acuity cases out of tertiary care centres. This will involve:
- Analyzing current case mix and developing recommendations to increase utilization of outpatient surgical sites.
- Analyzing current case mix and assessing against leading practices to identify recommendations, including policy and procedures, to maximize use of outpatient and acute surgical sites.
- Developing an implementation plan for recommendations.
Optimize the Master Block Schedule: Increase access to OR time for elective cases by adjusting Master Schedule to balance patient needs, resource availability and urgent care. This will involve:
- Conducting analysis to develop recommendations to adjust the block schedule to improve resource utilization and patient flow.
- Analyzing patient needs, utilization, and constraints of current block schedule.
- Revising the Master Block Schedule to balance perioperative resources and needs to enable flow.
Resources:
Communications & Standard Operating Procedures (SOPs)
You can review initiative communications, standard operating procedures and other resources below.
Proceed without confirmed bed
Advanced surgical booking
- Communication
- Standard Operating Procedure (Updated July 17)
Perioperative performance review process
- Communication
- Site Specialty Standard Operating Procedure
- Physician Level Reporting Standard Operating Procedure
OR block release policy
Waitlist room first case
Interested in supporting these initiatives or learning more?
Team members who have questions about these initiatives, the new standardized operating procedures, or who are interested and passionate about supporting these improvements, are encouraged to reach out to their manager, Department / Division Head or Megan Arsenault, clinical project lead, Central Zone Transformation Office.
Thank you again for so openly sharing your experiences and ideas.
We will provider further updates here, and through other channels, as this work progresses.
| Executive Action Team Members | Operations Panel Members |
|
|
