Surgery

Reengineering the OR and Redesigning Surgical Inpatient Flow for Improved Quality, Safety and Throughput. For more information about IHO programs and services, please contact us.

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University Health Network (Phase I-II)

• Created additional operating capacity to 105-110% and cleared surgical backlog from 4300 down to 3200 cases; performed over 1,000 additional surgical cases during the COVID pandemic 
• High compliance with wait time for urgent/emergent surgeries by an additional 13% to 20% for UHN hospitals (significantly reduce patient mortality and length of stay)
• Improved patient placement in the preferred unit/bed
• Provided strategies to optimally ramp surgical activities back up to reduce the provincial backlog  
• Well-positioned the Surgery Leadership team to manage the COVID-19 pandemic 
• Related Articles:
  • How Hospitals Can Save Lives and Themselves Lessons on Patient Flow From the COVID-19 Pandemic
  • How surgical smoothing could help ease the medical backlog created by COVID-19
  • COVID-19 surgery delays can be done without overburdening workers, say experts

Mayo Clinic, Jacksonville, Florida (Phase I)

• Surgical case volume increased by 4%
• Surgical minutes and OR utilization increased 5% each
• Average OR overtime staffing decreased 27%
• 84% compliance with waiting time limits for emergent and urgent care
• No reported incidences of not being able to access OR in a timely manner
• Annual staff turnover cost reduced by $1.07 million
• OR annual net revenue increased by $5 million
• Article: Re-engineering the Operating Room Using Variability Methodology to Improve Health Care Value

Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (Phases I-III)

• Weekday OR waiting time for emergent/urgent surgical cases reduced by 28% (despite an increase in case volume of 24%) (Phase I)
• Weekend OR waiting time decreased by 34% despite an increase in volume of 37%) (Phase I)
• OR overtime reduced by 57% (Phase I)
• Surgical throughput increased by 5% (an equivalent of an additional OR) (Phase I)
• Multi-year 7% increase in annual surgical throughput without adding new ORs (Phase II & III)
• $115 million increase in annual revenue/cost savings (Phase II & III)
• Over $100 million in avoided capital cost (Phase II & III)

The Ottawa Hospital, Ottawa, Ontario (Phase I)

• Improved access for patients needing emergency surgery within 24 hours from 60% to 90%
• Reduced mortality rate for patients requiring urgent surgery from 3.9% to 3%, resulting in 40 lives saved
• Achieved efficiency gain equivalent to $9million by decreasing length of stay and better use of beds
• Reduced surgery cancellations due to bed shortages from more than 600 per year to zero
• Reduced Neurosurgery inpatient census from 46 to 33, resulting in a savings of 13 beds
• Related Articles
  • More cost-effective health care needed
  • Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study

The Johns Hopkins Hospital, Baltimore, Maryland (Phase I)

• Waiting time for emergent/urgent surgical cases decreased by 39%
• Throughput increased by 5 cases per day in the main ORs and by 4 cases per day in their outpatient facility
• Overtime decreased by 6.6%
• Relative increase in surgical volume resulting in annual $4 million increase in incremental margin

Boston Medical Center, Boston, MA (Phase I and Phase II in one unit)

• Surgical throughput increased by 10%
• Emergency Department ambulance diversions reduced by 20%
• 2.8 hour wait in one of the state’s busiest EDs compared to 4-5+ hours for most academic hospitals in Boston
• Annual number of postponed or cancelled elective surgeries reduced by 99.5%
• Reduction in nursing stress levels: 30 minute reduction (6%) in nurse hours per patient day in the step-down unit, resulting in $130,000 annualized reduction in nursing costs

Palmetto Richland Memorial Hospital, Columbia, SC (Phase I)

• 3% increase in surgical volume
• 38% decrease in weekday waiting time for non-elective cases
• Opportunity to further increase surgery volume with $8m projected annual margin increase with $2 million achieved in the first year

HackensackUMC Mountainside, Montclair, NJ (Phase I)

• Improved elective OR block utilization resulting in increased capacity for 1,000 cases annually without additional resources
• More than 95% of emergent/urgent patients can access the OR in a timely manner, thereby decreasing their ALOS by almost 40%

Monmouth Medical Center, Long Branch, NJ (Phase II)

• Increased patient satisfaction score from the 88th  to the 99th percentile of comparable hospitals
• Decreased variability in nurse workload (number of admissions, transfers, and discharges) by over 40%
• Significantly decreased PACU boarding
• Increased throughput resulting in an annual margin improvement of $411K

Great Ormond Street Hospital for Children, London, England (Phase II)

• An average increase of 2.2 cardiothoracic theatre procedures per week (representing a minimum increase in annual revenue of £1.72 million), meaning that they can treat more children urgently requiring specialist surgery
• A decrease of 2.5 stress-related nursing shifts lost per week, representing an annual saving of more than £30,000 in agency costs
• A weekly decrease of 2.3% in theatre procedure cancellations
• An increase in theatre utilization from 55-60% to 80%
• PowerPoint Presentation of the project can be downloaded here

Elliot Hospital, Manchester, New Hampshire (The largest Maternity Ward in New Hampshire)(Phase I)

• Eliminated morning chaos
• Reduced the demand for additional staffed beds by 6 positions (50%)
• Improved quality of care