In this posting I want to shift gears a bit and talk about
some real problems facing healthcare today.
This posting is based upon conversations I’ve had with Vicki Harrison of
Optimium Health, Inc. As you will see,
Vicki’s company has some great solutions for problems that have plagued
hospital perioperative services for some time.
I know of these problems because I have been confronted with them on my own
healthcare consulting engagements.
Specifically these problems are centered on work flow into and out of
surgical units. I only wish that I had
met Vicki sooner!
The facts are in:
- FACT 1: 42% of hospital revenue is generated by the operating rooms
- FACT 2: Only 68% of OR’s run at capacity
- FACT 3: By increasing throughput by 1 additional procedure per day per OR suite, an average size hospital can generate $4-7M in additional revenue [1]
A Baltimore Health System and Optimium
Health, Inc. partnered to optimize workflow and efficiency for the purpose of providing
more efficient patient care and improving the financial health of the hospital
while increasing patient and nursing satisfaction. The initial implementation
is at the systems 467 bed hospital which performs over 20,000 surgical
procedures per year. The health system
and OHI realized that to date, no one has approached process improvement in
healthcare by combining Lean methodology with specific workflow automation
tools for the explicit purpose of more efficient care delivery. With mandates
being required by CMS and other government organizations, to reduce costs,
while delivering a high quality of care, better care coordination and increased
transparency, process improvement has to have a greater impact. As the OR
accounts for a large share of an organization’s expenses and resource demands, improving
the effectiveness of perioperative services goes a long way to increasing the
financial health in healthcare organizations.
Optimium Health has developed amazing new software
that more or less synchronizes all of the required activities needed to prepare
a patient for surgery. They call their
product OPTIMI$ER and based upon results seen during Phase I it is worth every
dollar spent.
Phase I Results Summary:
$1,088,000 Net of Increased Revenue and Expense Reduction for Pre Anesthesia
Screening Services: Note – Results below reflect only patient clearance process
not a full perioperative setting implementation.
- $408K = OPTIMI$ER’s direct impact on improved RN productivity allowing for increase in patient volume with no increase in staff
- $780K = Anticipated in reduced DOS cancellation by 1 case per day
- 78% = Increased staff satisfaction
- Return on Investment = 2 months
Let me stop for a second and ask you some workflow
questions about your own hospital:
- Does your hospital or practice lose revenue due to surgical delays or cancellations?
- Do scheduling glitches leave your operating rooms idle too often and too long?
- Do your clinicians spend more time doing clerical tasks than they would like?
- Is interoperability between your IT systems limited or non-existent?
- Do
problems arise because manual
information exchanges between departments and caregivers are error prone, untimely, and difficult to
read?
If you
answered yes to any or all of these questions, then Optimium Health’s new
software can help. It should be understood that Optimium Health supports
operational excellence in provider healthcare organizations and they have proven
solutions that: 1) streamline and synchronize clinical workflow, 2)
significantly improve financial results, and 3) enhance the patient experience
and 4) improve the morale and effectiveness of healthcare employees. I know I was impressed with the results I
have seen, especially in Phase II of their implementation.
In Phase II,
the scope was redefined to include
- DOS (Reduction in delayed first case starts and cancellations)
- Real-time analytics dashboard reports (cancellations-reason, delays-reason, first case start offenders, huddle, PACU boarder)
- Follow
up calls (readmission prevention)
The
financial opportunity in Phase II was an additional $3-7 M in revenue and/or
cost avoidance. But before I get into
Phase II, let me give you a bit of background information that most healthcare
providers will relate to.
Optimium’s partner hospital is located in Baltimore,
Maryland and is a part of a health system.
It provides a broad array of high-quality, cost-effective health and
health-related services. The hospital has 467 acute beds, is a level II trauma
center, and performs over 20,000 surgeries per year. Central to its role is the
provision of undergraduate and graduate medical education; approximately 400
medical students receive clinical training each year. It also provides educational
programs to other health professionals, employees and the community at
large. The hospital is a non-profit
institution with a mission of providing quality patient care, teaching and
research and is a Magnet designated facility.
Project Description:
Goal 1: To increase effectiveness, efficiency and
utilization of nursing staff in the Pre Anesthesia Screening Services (PASS)
Department with the overall objective to increase
patient volumes with existing staff while providing quality care.
Goal 2: To
effectively apply workflow automation technology that would optimize staff
performance and increase existing technology interoperability, while increasing
patient and staff satisfaction.
Department Overview:
PASS is responsible for performing pre-surgical
testing on approximately 50% of the 20,400 surgical patients per year and
clearing 100% of them for surgery. The department is staffed by 6-8 RN’s and
2-3 NP’s per day. Four RN’s spend
approximately 40% of their time on the clearance
process which is time away from seeing patients. This has been a constant complaint that I
have experienced on my healthcare engagements involving surgical units.
The Issues:
- Although the hospital had a very robust IT infrastructure and utilized an enterprise IT vendor for surgical scheduling, nursing and clinical documentation, there was no interoperability (i.e. synchronization) between the three modules. RN’s clearing patients for surgery were required to access and input patient information in to three separate locations. Sound familiar?T
- The surgical schedule was not updated in real-time so many times an RN would work on clearing a patient for surgery who had already been moved or cancelled. Sound familiar again?
- The staff were in 3 different locations and charts
would be carried from one location to another if another staff member needed
the chart. As Yogi Berra said….deja vu
all over again.
Current State:
Using Lean methodology, Optimium Health held
meetings with the peri-operative management team and subsequently, PASS staff
to define current state and map out workflows as well as what would be future
“best practice”.
- The hospital’s current state day of surgery cancellation rate is 9% which is above the national average of 5%. This is due in large part to preventable “waste” in current state workflow process:
- An increasing number of 24-hour “Add-Ons”, many of which are missing patient chart information.
- An information exchange breakdown between physician offices and PASS, leading to missing or incorrect patient chart information being sent to PASS.
- A lack of existing technology interoperability which creates “waste” in the form of time lost to duplications, omissions, and errors when transcribing information from one system to another.
Additionally, the hospital’s current state process
uses valuable clinical resources in clerical functions in a manner that
improves success but limits throughput:
- 42% of an RN’s Time is Spent Doing Clerical Tasks
- 20% schedule reconciliation
- 22% chart reconciliation
In terms of scale, the hospital schedules an
average of 100 surgeries per day, 260
days per year. With a 9% day of surgery cancellation rate, this means
approximately 2,340 surgeries are
cancelled each year resulting in up
to $7 million in lost or deferred revenue (based on a conservative per
surgical case revenue average of $3000). Even if the case is postponed, it negatively impacts operating room utilization for that day
and is, therefore, a lost opportunity cost.
In other words, it’s another potential revenue gain.
Key Beneficiaries:
So assuming this effort is successful, there
are multiple beneficiaries.
PASS
- PASS
provides clinical services prior to a surgical procedure. PASS RNs’ clinical
responsibilities include: General patient work-up, Lab draws, EKGs and entering
patient data into the enterprise EHR, with additional support functions (phone
calls, faxes, etc.). These same services can be provided by outside physician
practices instead of PASS. The patient’s surgeon may have referred the surgical
patient to an independent office rather than PASS to continue the flow of
surgical referrals from that office. This passing off of patients between
physician practices (primary care physicians and surgeons) creates a number of
problems for the hospital that would be far greater if not for the PASS staff
who act as a stop gap measure to prevent OR case cancellations or delays. Thus, the constituent groups who will benefit
from the implementation of this PASS
workflow solution includes:
- Patients – improved quality of care due to more timely and accurate information exchange between caregivers. Shorter wait times for surgical procedures.
- PASS Staff – Higher job satisfaction due to 1) more time devoted to clinical vs. clerical tasks and 2) less stress related to defective information exchanges.
- Surgeons & Surgical Staff – increased on-time surgical case starts due to the reduction of errors, omissions, and duplication that can cause case delays and cancellations and increased PASS staff satisfaction.
- Hospitals –
1) Reduction of surgical case delays,
often resulting in overtime charges,
and a reduction of case cancellations,
considered lost revenue and 2) better
PASS staff resource utilization due
to the reduction of preventable “waste” in an inefficient process.
So the question becomes, how is Optimium
Health (OH) doing thus far in Phase I?
Take a look at these preliminary results:
Financial
Benefits:
Year I = $1,088,000 Net Revenue
After Expenses
Increased Day of
Surgery Throughput: OH is
on-track to add one surgical case per day with a very conservative
reimbursement rate of $3K yields additional revenue of $780K/year.
Lower Costs –
Better RN Utilization: Overall
improvement of full-time employee productivity equates to 1.35 FTE’s. The
hospital opted to redirect 1 FTE to a fee for service area within PASS to open
a new book of patients. The remaining 0.35 FTE has been redirected to help for
2 hours in pre-op on the day of surgery with the aim to improve on-time starts
and to reduce cancellations.
Increased Revenue – New Book of PASS
Patients: An additional book of 14 PASS patients per
day was opened, 5 of which are fee paying, which equates to net revenue of
$292K/year.
Reduced Supply Costs: $8K saved in paper, FAX ink, toner, and
maintenance due to automating faxes sent.
Return on Investment (ROI):
- 1.5 months Year I
- 1 month Year II and beyond
Staff Satisfaction:
+78% Improved PASS RN and Manager Satisfaction
All-in-all,
using very conservative estimates, these are very impressive results. Phase II
will be underway shortly. I suspect that
when Phase II is fully ingrained in the hospital, the cost for OPTIMI$ER will
have been recovered many times over.
If you are a
regular follower of my blog, you know that I have very seldom ever endorsed a
product. But having been involved with
the same and similar healthcare organizations, I feel I would be remiss if I
didn’t report on this product. If you’re
interested in hearing more about this revolutionary product that truly
synchronizes work flow, you can contact Vicki Harrison at her contact info
below. I encourage you to visit their
website as well at the following link: http://www.optimiumhealth.com/
Vicki Harrison:
439
Ferry Point Road; Annapolis, MD; 21403
Office:
410.295.1298
Mobile:
443.994.0189I want to thank Vicki for her excellent work in helping healthcare organizations improve their throughput of surgical patients.
Bob Sproull
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