While operating room (OR) leaders and clinicians are committed to delivering quality patient care, most are not trained to be IT systems experts. Silos frequently emerge between OR leadership and IT department support staff, even though the surgical department’s daily operations depend heavily on Surgical Information Management Systems (SIMS) receiving ongoing maintenance.
The COVID-19 pandemic forced hospitals and ASCs to postpone elective surgical cases, devastating the top line revenue of almost every facility in the US. Now that normal surgical operations are resuming, one of the issues operating room leaders will face is how best to capture the postponed surgical volume in a cost effective and safe manner.
As an operating room leader, have you ever thought about how well the databases in the SIMS are kept up to date? Now may be an opportune time to review the primary database files your SIMS uses to run your operations to ensure the surgical department can function optimally. While there are many databases your SIMS uses daily, two the of most important databases used to manage the department are the Master Procedure File and the Surgeon Preference Card Library. These two databases provide source data for:
- Surgical procedure volumes
- Utilization
- Specific room performance information such as:
- First Case On-Time Starts (FCOTS), Turnover Time (TOT), Block Utilization, Add-On Cases, etc.
- Specific surgeon information
- Service line performance
- Costs
- Overall financial performance
Chances are that if you were involved in the SIMS implementation process, you focused on documentation content and workflows. During most implementations, large SIMS vendors are under pressure to finish implementation projects on tight timelines and even tighter budgets. Due to these restrictions, streamlining the underlying databases the OR system uses is often an afterthought. When the opportunity presents itself, ask these questions of your Perioperative IT support person or the IT department leaders:
- Was there a Master Procedure file standardization process in place prior to starting a new implementation project?
- Was the Master Procedure File cleaned up and standardized prior to upload into the new SIMS?
- Is there a process in place to provide standardization to all Master Procedure File modifications?
- Was the Preference Card library cleaned-up and standardized prior to its final uploaded or was a previous or existing version utilized?
- Did a Preference Card content review take place to validate procedure length / set up / clean up times to ensure each individual surgeon’s information was accurate?
- Do the supply items listed on the preference cards directly reflect the information from your Materials Management Systems Item Master File?
If the answer to any of the questions above is no, you may be facing issues that impact your ability to optimally manage your surgical department.
Many hospitals that have not standardized the Master Procedure File (MPF), resulting in duplicate or multiple procedures with differing names that correlate back to a single CPT-4 code. If you have a system administrator or Perioperative Business Manager routinely running reports, your information system will often not pull data from the database accurately unless all the naming variations of the procedures listed in the MPF are known beforehand. Incomplete or skewed data commonly leads to flaws in evaluating how the Operating Room is functioning. These can include, but are not limited to:
- Inaccurate procedure or service line volumes
- Case costing errors
- Scheduling errors
- Inconsistent documentation and quality assessments
- Billing and charging inaccuracies
- Desired surgeon preference cards inconsistently matched to scheduled procedures
Many hospitals have discovered that they are flying blind when managing the operating room in a post COVID-19 environment, and having a well-functioning operating room is critical to a hospital’s overall financial success and security.
The other database integral to a well-functioning operating room is the Surgeon Preference Card File. Some operating departments have taken time during the slowdown in procedures due to COVID-19 to clean up their preference card library (database). In general, cleaning up preference cards is a tedious and complicated process requiring coordination between many groups that function within Perioperative Services. Chief among these groups are Surgeons, Materials Management, and the Service Line leaders.
Patient throughout considerations are frequently not factored into preference card clean-up initiatives. Effective preference card design incorporates clean up times and links this to the following procedure’s case set up time. The time between clean up end and set up start time for the following procedure is commonly called Idle Time. If you can successfully shrink the Idle Time amount, you may find more schedulable minutes for additional cases throughout the day.
Another factor to consider is how the scheduling system calculates turn-over times. Is the set up and clean up time combined? Are they tracked separately? What is the source of these time estimates? Is it actual or was it entered as a guess when the SIMS schedule system was set up? Do the schedulers enter set up or clean up times at their discretion? This is an area during a typical operating room day where available time seems to vanish. In most SIMS, there is no easy way to gather this information in a tool, but if you can understand and expose the thought process during the set-up of the SIMS, it would reveal obvious flaws in the methodology hiding from OR leadership.
Internal hospital resources are often limited, and the domain expertise required to update IT resources is deep and wide. Before starting a much-needed MPF and preference card database update project, consider the creation of a governance structure to help develop the plan and oversee the initiative. Governance members should include clinical supply chain, RCM, Information Technology, and most importantly, OR clinicians and leadership. The underlying goal of updating the MPF and Preference Card databases is to provide accurate reporting necessary to manage the Operating Room and understand its financial impact on the organization.
The COVID-19 pandemic has amplified how valuable Surgical Services are to the financial health of a hospital and ambulatory surgery centers. Taking the time to update your Master Procedure File and Preference Card databases will help administrators and operating room leadership to address traditional operational inefficiencies, ensure accurate reporting, result in improved operating room throughput, and help mitigate the procedure backlog exacerbated by the COVID-19 pandemic.
