IMO: Given your expertise in the perioperative space, what are some of the biggest challenges currently facing those professionals? I know labor shortages are a prominent concern.
Janice Kelly: Staff recruitment and retention is not a new problem, but it has intensified in the last several years due to the nursing shortage and the COVID-19 pandemic. A significant challenge is ensuring we have the right nurses in the right situations to provide patient care in the perioperative setting. Prioritizing capacity management is a critical priority to address staffing shortages. Leveraging analytics and artificial intelligence (AI) can help organizations effectively manage their operating room (OR) utilization and staffing. However, the accuracy of these analytics hinges on a clean surgical procedure dictionary – as the saying goes: Garbage in, garbage out.
IMO: Absolutely. If an organization has a poor surgical dictionary, it can cause a whole slew of issues. Can you speak a bit about how surgical terminology impacts efficiency in the OR?
JK: Adopting a standardized naming convention for surgical procedures enhances communication and ensures more consistent scheduling of the correct procedures. Consistency aids technologies like analytics to help accurately determine average case times and durations in order to improve OR utilization. Additionally, a well-maintained surgical procedure file guarantees that the appropriate preference card is matched with each case, ensuring the correct room setup and reducing the likelihood of OR delays. Decreasing delays bolsters satisfaction among patients, staff, and surgeons and elevates patient safety.
IMO: Given your experience, are there any tips you can give OR professionals?
JK: Perioperative nurses and leaders must actively participate in problem-solving, lest others impose solutions that may not align with our preferences. We must be involved in discussions and support innovative approaches to our challenges, acknowledging that not all attempts will be successful. Only through trying can we discover practical solutions. We should also explore current technologies to assess their potential to serve multiple purposes.
Consider, for example, using a standardized surgical procedure list with Current Procedural Terminology® (CPT) or other code set mappings to aid communication during scheduling workflows. When a clinician schedules a procedure using a CPT code rather than its name, the scheduler, unfamiliar with the CPT code, can enter it into the system, providing a list of procedures linked to that code. This method enhances communication, mainly when different communication methods are used between two parties. Similarly, these CPT mappings can be leveraged in pre-authorization workflows to minimize claims denials, as the CPT codes linked to the procedures are those typically billed and required for prior authorization.
IMO: What technologies or innovations have you seen significantly impact efficiency in the operating room?
JK: The increasing demand for care, limited resources, and rising costs underscore the need for technological innovation to boost efficiency. In the context of OR efficiency, data collection is vital for monitoring and pinpointing issues.
Key efficiency metrics include:- The total number of cases
- OR utilization rate
- Same-day cancellation rate
- First case start times
- Accuracy of case duration estimates
- Turnover times
While electronic health records (EHRs) may offer foundational data, prescriptive analytics extends beyond by suggesting actionable steps to enhance OR efficiency. It enables the crafting of optimal surgery schedules by considering variables like surgeon block times, patient priorities, and resource distribution. Through historical and real-time data analysis, prescriptive analytics can recommend the most effective scheduling to reduce downtime and improve overall utilization.
Machine learning (ML) further amplifies this approach by learning from past data to forecast future outcomes. It can analyze historical patterns of canceled surgeries to predict potential future cancellations, enabling the development of workflows to reduce cancellation rates by addressing common causes. One innovative workflow could be automating notifications, such as reminding patients of preoperative preparations and informing vendors and their representatives about the need for implants and special instruments.
IMO: Do you have any advice for organizations looking to evaluate tech to improve OR efficiency?
JK: Healthcare technology should prioritize patient safety, minimize delays, and enhance care coordination. Improving workflows and reducing waste is key to increasing efficiency. Technology adoption must be tailored to meet the specific needs and objectives of the perioperative environment. We can boost efficiency, streamline processes, and enhance patient outcomes by leveraging technology. It’s crucial to involve nurses in evaluating technology, as their input is vital for successfully accepting and implementing new workflows.
IMO: We’ve been asking other healthcare professionals what they predict will happen with AI in healthcare in the next year or five. How do you see it playing a role in the OR?
JK: Some facilities have already implemented an “OR Black Box” – or high-resolution cameras and microphones – to evaluate surgeons to improve quality and efficiency using artificial intelligence. We could use the same technology to assess team communication and other operational workflows to foster efficiency and quality improvements. What’s more, this equipment can be used to support telemedicine or vendor representative services during procedures.
Imagine the potential of integrating video, AI, and ML to scan the room before a procedure begins, identifying any missing equipment or instruments. This system could also detect specific actions during the surgery and automate the documentation process, such as recording incision and surgical end times and monitoring staff movements in and out of the OR.
AI can further assist perioperative nurses by providing rapid access to clinical information based on the AORN Guidelines and other reliable sources. An electronic, interactive checklist could streamline room turnover processes, ensuring all steps are completed promptly. It could issue automatic updates to relevant staff and notify them when the OR is prepared for the next patient. Alternatively, this checklist might serve to verify proper patient positioning, offering guidance and support as necessary.
IMO: Are there any common pitfalls to OR efficiency that you see? If yes, how can organizations avoid them?
JK: One of the critical obstacles to OR efficiency is the failure to collect data necessary for pinpointing the actual issues affecting your organization. The initial step towards tackling these efficiency problems is measurement, which allows for a better understanding and management of the issues. It’s crucial to ensure clean data is gathered from appropriate points within the EHR system and employ standardized metrics to facilitate benchmarking against other organizations. Following the implementation of workflow enhancements, it’s essential to persist in monitoring these metrics to confirm that improvements are sustained or further progress is achieved.
