Improving Efficiency and Staff Satisfaction in the Operating Room in a Rural Community Hospital

Transcript

1. Juli R. Forbes DNP, RN & Jennifer Mitchell BSN, RN Improving Efficiency and Staff Satisfaction in the Operating Room in a Rural Community Hospital
2. 2 OUR MISSION To improve the health and well-being of eastern North Carolina OUR VISION To become the national model for rural health and wellness by creating a premier, trusted health care delivery and education system. OUR VALUES Integrity Doing the right thing Compassion Connecting, caring and comforting unconditionally Education Learning, adapting, improving and transforming Accountability Taking responsibility for what we do Safety Achieving zero harm to patients, visitors, families and team members Teamwork Contributing to our goals
3. 3 System of care reaching more than 1.4 million people across 29 counties. Northampton Hertford Gates Bertie Martin Washington Tyrrell Dare Hyde Beaufort Pitt Halifax Nash Wilson Edgecombe Craven Jones Lenoir Greene Wayne Duplin Onslow Carteret Pamlico Chowan ECU Health Medical Center Greenville ECU Health Roanoke-Chowan Hospital Ahoskie | 1948 ECU Health North Hospital Roanoke Rapids | 1972 ECU Health Edgecombe Hospital Tarboro | 1959 ECU Health Duplin Hospital Kenansville | 1955 ECU Health Bertie Hospital Windsor | 1952 / 2000 ECU Health Chowan Hospital Edenton | 1947 Outer Banks Health Hospital Nags Head | 2002 ECU Health Beaufort Hospital, a Campus of ECU Health Medical Center Washington | 1958
4. ECU Health Beaufort Hospital | Service Area 4 Northampton Hertford Gates Bertie Martin Washington Tyrrell Dare Hyde Beaufort Pitt Halifax Nash Wilson Edgecombe Craven Jones Lenoir Greene Wayne Duplin Onslow Carteret Pamlico Chowan ECU Health Beaufort Hospital, a Campus of ECU Health Medical Center Washington | 1958
5. ECU Health Beaufort Hospital | Services & Specialists 5 Inpatient Care Emergency Department Labor & Delivery Neonatal Nurse Practitioners Laboratory Services Outpatient Oncology and Radiation Radiology CT, MRI, PET, X-Ray, Nuclear Medicine Telemedicine Stroke, Psych, Neonate Rehabilitation Surgical Services Hospitalists Cardiologists Intensivists Virtual
6. ECU Health Beaufort Hospital | Awards and Recognitions 6 Stroke Gold Plus with Target: Type 2 Diabetes Honor Roll Rural Stroke Gold Coronary Artery Disease STEMI Referring Center Bronze Resuscitation Bronze Rural Coronary Artery Disease STEMI Gold
7. ECU Health Beaufort Hospital | Statistics 7 5,476 Admissions Fiscal Year 2025 3,543 Surgeries 294 Births 60+ inpatients on any given day 23,876 ED Visits 21,759 Outpatient Visits
8. ECU Health Beaufort Hospital | Surgical Services 8 o 3100 OR Cases Per Year o Orthopedics, General Surgery, Ophthalmology, Urology, Ob/Gyn o RN, MD, CRNA, RNFA, Surgical Tech, ORA, Housekeeping, Central Sterile o Ambulatory Surgical Unit o Endoscopy Lab o Post Anesthesia Care Unit o Central Sterile & Reprocessing o Six Operating Room Suites
9. Literature Review o In small rural hospital operating suites, small shifts in demand for operating room (OR) block time can significantly impact staff efficiency and workload. Conventional efforts to boost OR efficiency often intensify pressure and workload on staff, potentially leading to trade-offs between efficiency and the quality of care.1 o OR efficiency depends on a much broader set of factors, such as case scheduling, staff allocation, equipment availability, preparation, performance of the surgery, and recovery time.2 o Improving efficiency in the context of provider and staff satisfaction is also a critical part of the OR quality- improvement process, especially in rural hospitals, where the outcomes of change may be more sensitive to seemingly small interventions.3 o An effective, person-centered approach to OR efficiency involves strategically allocating staff, equipment, time, and resources to enable high-quality surgical performance and improve staff satisfaction.2 o Rural hospitals often operate with fewer resources and face specific challenges that affect efficiency, including limited access to specialized staff and fluctuating patient volumes.4 o Block scheduling, which assigns specific time blocks for surgical procedures, enhances predictability and resource allocation, and improves staff productivity and satisfaction by minimizing gaps between procedures and mitigating the risk of delays.5 9
10. The specific aims were to: 1) Decrease after-hours OR usage 2) Increase OR block utilization to greater than 75% 3) Maintain surgical services staff satisfaction By implementing a four-day- 10- hour operating schedule. Specific Aims
11. Methods 11 Pre-Implementation: Survey of staff satisfaction and perceptions of anticipated change. OR time data extracted and analyzed from EPIC Improvement Implementation: Block Scheduling Transition Began January 2023 Staffing Schedule Modified to Accommodate New Block Times Post-Implementation: Post-Survey of staff Extract and analyze pre and post OR time data
12. Methods – Pre Implementation 12 Pre-Implementation: Survey of staff satisfaction and perceptions of anticipated change. OR time data extracted and analyzed from EPIC 35 28 17 11 18 2523 1939 1223 768 1321 0 500 1000 1500 2000 2500 3000 0 5 10 15 20 25 30 35 40 M-F 330 - 5pm M-F 5-7pm M-F 7-9pm M-F 9-11pm M-F 11p-7a Total Minutes # of Cases OR After Hours FY22 Case Count Total Room Time Friday OR Utilization = 15%
13. Methods – Implementation 13 Improvement Implementation: Block Scheduling Transition Began January 2023 Staffing Schedule Modified to Accommodate New Block Times ECUH Beaufort OR Block Schedule 4/10 Hour Days
14. Methods – Post Implementation 14 Post-Implementation: Post-Survey of staff Extract and analyze pre and post OR time data
15. Results – Staff Satisfaction 15 Perceptions of Work-Life Balance 68% 79% Perceptions of Adequate Surgical Tech Staff 50% 62% Perceptions of Adequate Nursing Staff 72% 92%
16. Results – Press Ganey Employee Engagement Survey In 2025, ECUH Beaufort OR Employee Engagement Survey thru Press Ganey scored in the top 87th percentile and showed +0.29 above the National Healthcare Average 16 3.93 3.89 4.26 3.5 3.6 3.7 3.8 3.9 4 4.1 4.2 4.3 4.4 4.5 2021 2023 2025 Engagement Indicator Operating Room -0.16 -0.12 +0.29 Pre Intervention Post Intervention During Intervention
17. Results – Block Utilization 17 Block Utilization 71% 84% Perceptions of ability to add elective procedures 70% 89% Perceptions of workload to allow additional OR volume 72% 72%
18. Loss of 3 General Surgeons and 1 Orthopedic Surgeon Results – OR Block Utilization 18 60% 59% 53% 51% 59% 58%58% 78% 56% 69% 75% 62% 72% 71% 84% 86% 87% 82% 86% 84% 82%82% 79% 82% 81% 78% 83% 81% 74% 83% 78% 79% 85% 82% 73% 72% 66% 65% 71% 82% 73% 74% 70% 78% 79% 84% 92% 89% 82% 86% 91% 40% 50% 60% 70% 80% 90% 100% Block Utilization Goal 75% Pre-Intervention Post-Intervention
19. Results – Surgical Growth 19 2,604 2,931 2,795 3,391 3,776 3,543 4,050 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 FY 20 FY 21 FY 22 FY 23 FY 24 FY 25 Ann FY 26 Pre-Intervention Post-Intervention
20. Sustainment o OR Block Utilization Review Committee o On track to exceed prior year surgical volume • Current volume annualized at 4.050 o Open Operative Services to 5 - 10-hour days • January 2026 go live for 5 days o Overall improvements have allowed for additional services including • Robotics • Plastics 20 ECUH Beaufort OR Block Schedule 5 / 10 Hour Days
21. Conclusion 21 EFFICIENCY IMPROVEMENTS MUST CONSIDER THE PEOPLE INVOLVED SOLUTIONS MUST LOOK BEYOND “WORK HARDER” OR “WORK FASTER” CREATING CAPACITY FOR NEW OR EXPANDED SERVICES DECREASED USE OF OVERTIME AND CALL TEAMS IMPROVING WORK-LIFE BALANCE DECREASED LABOR COSTS
22. References 1. Goldhaber, N, Schaefer, R, Martinez, R, et al. Surgical pit crew: initiative to optimise measurement and accountability for operating room turnover time. BMJ Health & Care Informatics. 2023; 30:e100741. doi: https://doi.org/10.1136/bmjhci-2023-100741. 2. Schouten AM, Flipse SM, van Nieuwenhuizen KE, Jansen FW, van der Eijk AC, van den Dobbelsteen JJ. Operating room performance optimization metrics: A systematic review. J Med Syst. 2023;47(1):18-31. doi: 10.1007/s10916- 023-01912-9 3. Kornelsen, J, Cameron, A, Stoll, K, et al. A mixed-methods descriptive study on the role of continuous quality improvement in rural surgical and obstetrical stability: Considering enablers, challenges and impact. PLOS ONE. 2024:19:e0300977. doi: 10.1371/journal.pone.0300977 4. Abdalkareem ZA, Amir A, Al-Betar MA, Ekhan P, Hammouri AI. Healthcare scheduling in optimization context: a review. Health Technol. 2021;11:445-469. doi: 10.1007/s12553-021-00547-5 5. Taaffe, K., Fredendall, L., & Weiss, R. Managing Service-Specific and Open-Posting Block Sizes when Allocating Operating Room Time. Quality Management Journal. 2018;25:18- 31. https://doi.org/10.1080/10686967.2018.1404371. 22
24. Questions?