Robert P Foglia
University of Texas Southwestern Medical Center, USA
Title: Improving perioperative performance: The use of operations management, communication, and the electronic health record
Biography: Robert P Foglia
Our health system had a strategic plan to recruit surgeons, develop new programs and shift volume outside of the Main OR (MOR) suite. Previously, many of perioperative processes were dysfunctional, data with paper charting often had inaccuracies, and physicians had a healthy skepticism of the data, leading to a lack of engagement. Our aims included optimizing space, personnel, and processes, developing performance metrics, setting clear expectations for resource allocation and sharing credible data with stakeholders. Perioperative performance improvement is the orchestration of a multidisciplinary team to achieve a series of goals, which are sustainable. Three elements were essential to achieve these goals, prompt communication with shared goal expectation, operations management, and the electronic health record (EHR).
The results from 2006 to 2015 were: a) cases increased from 19,148 to 29,308 (53%), b) block utilization increased from 47% to 72% (+53% ), c) on time starts increased six-fold (12% to 80%), d) case cancellations reduced 3-fold (14% to 4%), e) MOR cases increased +2%, f) cases outside of MOR increased from 5,606 to 15,443 (+175%), while MOR cases increased 2%, g) revenue increased 99%, from $116M to $231M in 2015. Prompt and consistent communication with physicians and perioperative leadership, the use of operations management to change processes, and the EHR resulted in marked improvement in multiple performance metrics and a concomitant increase in engagement and "buy in" by physicians, administrative and nursing leadership.