Smarter surgical decisions supported by data: Mississippi hospital uses IT to gets its arms around surgical scheduling, inventory control, documentation and staff utilization
There is the forest, and then there are the trees. At Memorial Hospital in Gulfport, Miss., a 425-bed medical/surgical community hospital, senior management is doing its best to lose sight of neither. In a quest to make Memorial an info tech-savvy hospital, everyone from the board of directors on down has signed on to a long-range vision of how the hospital will look five and 10 years down the road. Everyone works toward that common goal.
The vision doesn’t include a module-by-module installation of applications connected to a module-by-module measurement of return on the investment. Rather, Memorial has taken a holistic approach based on a strategic plan. The entire focus is on providing high-quality healthcare to its community, and information technology is one of the tools to take it there.
Work Behind the Scenes
Hospital surgery departments are a top revenue producer, but expensive to operate. Surgery departments need to run like clockwork in terms of OR scheduling, staff utilization, inventory, documentation and charge capture.
Like many community hospitals, Memorial has a predictable volume of surgeries through its eight surgical suites. The hospital performs approximately 5,000 surgical procedures per year and has about 75 surgeons on staff. But the hospital was plagued with a manual, paper-based system for managing the flow of cases, scheduling and supply logistics, which essentially negated the value of having a predictable volume of surgeries.
Inconsistent scheduling and coordination caused gaps within the surgical services schedule. This lead to excess labor costs, poor resource utilization, poor on-time case starts and cases performed outside of OR “open times.”
Paper was the problem. To properly process a surgical case, staff needed about 15 separate forms to get release of inventory, charging and documentation completed, just to match cases to accounts. Of course, paper leads to duplication of effort, lack of coordination and opportunities for missed documentation. But most troubling was that the litany of paper trails did not provide the checks and balances Memorial needed to make its OR run like clockwork.
Memorial’s surgical services nursing staff also needed help. Nurses would record post-case documentation on paper, which then had to be transcribed and entered into the healthcare information management system. As a result, there were integration pitfalls between documentation and supplies and charging on the back end.
Statistics indicate that 40 percent to 50 percent of hospital revenues come from surgical cases, yet operating room suites are generally underutilized. While Memorial registered a 60 percent to 70 percent OR utilization rate, there was room for improvement and for increased revenues. “There was an awful lot of work done outside of the surgical suites to make sure that OR rooms were not clogged by paperwork,” said Beverly Ernst, R.N., informatics coordinator and clinical project manager at Memorial.
Efficient Use of Resources
Memorial selected McKesson’s Horizon Surgical Manager to help staff take control of resource management in the surgical services department. The organization was already familiar with McKesson solutions, having both scheduling and material management applications in place.
Darlene Martin, systems administrator and NT analyst at Memorial, says the surgical search team was given free rein to explore, test and compare applications, and to select the one they thought would be the best fit. As it happened, the team liked Horizon Surgical Manager, but at the time they tested it, it didn’t have a charge capture component. So Memorial went live with the system for three mouths, then beta-tested the newly developed charge module, and finally went live again with the whole application in October 2002.
“Now we can schedule procedures into the blocks of time that are more appropriate for their duration, so we can utilize time better in the surgical environment. This allows improved OR turnover and more productive usage of the suite, which is extremely expensive,” says Ernst. “With scheduling, we can average procedure times after the fifth procedure of the same type to reflect what the mean time is.”
After the first month live on the system, Memorial increased its surgical services’ volume adjusted gross revenue by 10 percent simply by using the charge capture feature. “One of the biggest benefits was management of supplies in the OR,” says Martin. She says Memorial is migrating toward just-in-time ordering. The maintenance and updating of physicians’ preferences on paper case cards is gone; preference changes initiated by physicians and inventory differences initiated by the hospital are entered and maintained electronically and are instantly accessible. Combined with automated resource scheduling, the hospital can make sure the necessary surgical supplies and equipment it needs are available, without having to maintain them in inventory for too long.
Use of Nursing Vocabulary
In a manual environment, Memorial had no idea why there were significant differences in the procedure costs by physician. With automated supply chain coordination for the OR, Memorial anticipates additional savings from better inventory management. “Now, if three physicians perform the same procedure and want the same tool, we have duration, cost and charge data. We can indicate to those doctors that the tool isn’t enhancing their time or performance, and we can suggest they consider using a more cost-effective alternative,” says Martin.
“We had a lot of inventory on the shelf that was case-specific to physicians,” said Ernst.
By knowing physician preferences, staff can better understand inventory and learn how to capitalize on product and pricing opportunities. Also, the hospital can avoid huge inventory adjustments on unused or expired supplies by ordering the right supplies in the right amount. “So many times, we had certain supplies and no one really knew why they were there. Now we know what’s in the surgical area and when it was last used. We can assess whether to stock it or not.”
The nursing staff also gained a surgical services tool that allows OR nurses to document all phases of perioperative care. The charting incorporates Perioperative Nursing Data Sets, a standardized nursing vocabulary developed by the Association of periOperative Registered Nurses. This allows patient care to be quantitatively tracked and outcomes measured, a critical element for a successful Joint Commission on Accreditation of Healthcare Organizations survey. The perioperative record allows for comprehensive clinical documentation, which includes the ability to document by exception.
Increased automation in the OR helped Memorial create a synergy that served as a model for several other technology implementations. Since they became comfortable with documentation in the OR, physicians now regularly use computers to access medical images via a PACS. Using an online physician portal, they can see their own scheduled surgeries and review patient data and surgical documentation electronically.
“The integrated surgical system is one of the key building blocks for us to get to clinical decision support,” said John Doulis, M.D., medical information officer at Memorial. “At the end of the day, paper might be easier for individuals, but it offers data and not information, trending capability or decision support. What we’re doing now with implementation of an OR system integrates well with other IT changes we have made. We have a PACS and bar code system, wireless technology, interface engines and remote access. In the future, we will add an emergency department information system with clinical decision support and a cardiovascular PACS. Toward the end, this will all help to work with physician leadership on charting a path toward CPOE.”
Doulis stresses Memorial’s adherence to the concept of building blocks in its effort to construct a tech-savvy future. “A healthcare organization’s technological foundation must consist of the right building blocks. Information technology contributes the information from the data, which evolves into decision support, and that leads to better decisions–for patients and for the hospital.”
For more information about Horizon Surgical Manager from Mckesson, www.rsleads.com/409ht-205
John Doulis, M.D.
Medical information Officer
Horizon Surgical Manager
COPYRIGHT 2004 Nelson Publishing
COPYRIGHT 2004 Gale Group