Hospital OR Monitor

Surgical Flow
How Patient-tracking Software Works
Patient-tracking software lets Mary Bradley, RN, MSN, manage the surgical flow of the 28 ORs she oversees at the University of Pennsylvania Presbyterian Medical Center. "I used to be on the phone all day to see where patients were and what stage of readiness they were in," she says. "Now, my computer screen is like a window into every room."

As patients arrive, the admission staff change the icon next to the names on the surgical schedule. Nurses then record the movements of patients through pre-op, surgery and post-op with strokes of designated hot keys on computers at stations throughout the hospital. The status of patients is even updated throughout a procedure - icons signify when a patient is being prepped, positioned and induced, when the first incision is made, the moment the surgeon begins to close the incision, and when the dressing is being applied to the surgical site.

Judy Patterson, RN, director of perioperative services at Hannibal Regional Hospital in Hannibal, Mo., says her patient-tracking system has been an invaluable resource to improve the hospital's outpatient surgery department. "You can't manage what you can't measure," she says, "and we had no way of measuring our performance before installing the tracking system."

Ms. Patterson is now able to implement block scheduling. Some of her physicians thought block scheduling wouldn't work, but she was able to pull up tracking records to show them they were already using the rooms during the times she wanted to schedule them, she says. The tracking system showed that her hospital's ORs were being used at 60-percent capacity; she's now using the data gathered from the tracking system to shoot for 80-percent utilization.

Another big benefit of the tracking program is the potential it offers for troubleshooting past surgical delays. Ms. Bradley can quickly determine when a backup in a room offers little hope for completing the scheduled caseload. That occurrence used to necessitate a series of frantic phone calls. Not anymore. Ms. Bradley can shift cases to free ORs - while also letting her staff know of the changes - by pushing buttons on her keypad.

You can also place a monitor showing the surgical schedule (using patient initials instead of full names) in your waiting room so loved ones of patients can follow the progress of surgeries without asking your staff for constant updates.

The costs of tracking programs are major concerns (for a 10-OR setup, one rep estimated $150,000 to $225,000 for a tracking system), but Ms. Patterson says she plans to recoup the cost of her system within a year because of the efficiency improvements her staff has realized.

To sell her boss on the idea, she first made sales calls to the staff. "I hit every area of the hospital that would be affected by a tracking system and convinced them it was a good fit for our hospital. Every manager then wrote a letter to the vice president of patient care as to why the tracking system would benefit us. That process really helped to get the project approved."

"Keeping track of OR activities used to be very labor intensive," says Ms. Bradley. "I don't even remember how I was able to accomplish my job before."

- Daniel Cook

Cost-saving Ideas
Inside an Employee-suggestion Program
The employee at Lehigh Valley Hospital in Allentown, Pa., who suggested that the hospital repair flexible endoscopes in-house saved the facility $367,000 over three years (See Why Not Repair Your Own Scopes on p. 42). He also got the repair tech job his idea created. Another suggestion to change OR bipolar cords saved the hospital $8,000.

The hospital's employee-suggestion program, dubbed "Working Wonders," saved the hospital $2.5 million in 2003 and $1.6 million last year. Since 1996, when Working Wonders was first implemented, LVH has saved $11.54 million on suggestions from 2,489 employees.

Here's how the concept works. Employees with ideas e-mail their suggestions to Jackie Straley, program manager for LVH. Ms. Straley has found that an e-mail collection system works far better than a drop box. She forwards the suggestions to the corresponding department head (for example, the perioperative nurse for an idea contributed by a surgical tech) to determine the feasibility of implementing the change. Ideas are in turn directed to a steering committee if the department head gives her approval.

An employee who submits a cost-saving idea that's accepted is eligible to receive 10 percent of the hospital's realized savings as a bonus (capped at $10,000). A group of employees who propose an accepted concept share 15 percent of the realized savings (capped at $22,500).

Staff participation is helped by drawings for small gifts to be given to employees who participate. But not all drawings are for trinkets; each employee who has an idea accepted is eligible for monthly prizes such as trips for two, laptops or 3,500 in cash.

Ms. Straley believes having a dedicated manager overseeing an employee suggestion program is essential to its ultimate success. Hospital staff, she says, will be more inclined to take a suggestion program seriously if it is well run and the facility's administration is dedicated to its cause.

To that end, Working Wonders is now ingrained in LVH's core training and hospital communication programs. "We tell new hires about the program during orientation, and I write articles on the topic for our monthly newsletter," says Ms. Straley. She also displays program information on tabletop tents in employee lounges, on posters throughout the hospital and on letters included in paychecks.

- Daniel Cook

Strange But True
During our JCAHO inspection, the inspector was reviewing our code cart and nearby cabinets. She noted one of our drawers was labeled "Large-bore Bacterial Compression Device." With an impressed expression, she asked, "What is that used for?" "It's part of our infection control program," I stated. She turned to our clinical educator and asked, "Can you in-service me on the use of this device?" Our clinical educator shrugged as she said, "Sure." She then opened the drawer, pulled out our flyswatter and began whacking a nearby countertop.

John Olmstead RN, MBA, FACHE
Director of Surgical Services
Johnson Memorial Hospital
Franklin, Ind.