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Surgery

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.

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:
  • 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 
  • Created the opportunity for UHN to perform over 3000 additional elective surgeries
  • 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 pandemic 
  • Related Articles:

 

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

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