How To Improve Block Utilization For Surgical Practices
Surgery accounts for around one-third of all healthcare spending, making time in the OR the main profit driver of every surgical center or hospital. But spending time in the OR does not come cheap. While each hospital or clinic has its own procedures and methods to ensure that OR time is maximized, there is a common practice engaged in by most – surgical block scheduling. This article discusses common block utilization pitfalls and suggests methods and tools that can help practices to overcome them.
It’s estimated that every minute spent in the OR costs in the region of $37. Which is why every surgeon wants to ensure that they are getting the best bang for their buck and maximizing their time. An OR that lies empty when it could be in use is an expensive liability for any surgeon and practice. Managing the high expense of an OR is a top priority which is why surgical block scheduling is so critical for surgical practices.
What is surgical block scheduling?
Essentially, surgical block scheduling is a method of allocating time blocks to individual surgeons to use as they wish, giving them the ability to plan ahead and decide how best to use their block of time.
The American Hospital Association recommends that 75% of the total surgery time for a hospital or clinic be blocked and the remainder be left for open scheduling – either for elective or emergency cases. If such a high percentage of time is to be blocked according to industry best practices, it is all the more imperative to ensure that these time blocks are well-utilized. In practice, however, this is more challenging than it sounds.
Benefits of surgery block times
The practice of dividing OR time into surgical blocks was devised as a way to make surgeons’ lives easier and provide for greater efficiency when allocating human resources and equipment. With this form of scheduling, surgeons are allocated predictable blocks in advance — usually as half days or full days — in which they can schedule surgeries as they see fit.
There are a lot of pieces that need to come together for a surgery to go ahead, to just a few:
- equipment arriving in the OR,
- the anesthesiologist to be available,
- support staff for pre- and post-op.
Blocking all the surgeries together ensures all the relevant parties involved are on deck for that period of time. Additionally, surgeons often like to block utilizations in order to perform similar categories of surgery together since the resources needed are often the same.
Challenges with surgery block time utilization
The goal of surgical block time scheduling is to make surgeons and practices more efficient and maximize OR usage; however, time blocks are not always used as efficiently as they could be. A study carried out by researchers at the Mayo Clinic and Clemson University gathering data from a large health-care provider discovered a missed opportunity to achieve over 2,900 hours of OR time savings through improved block utilization.
Surgeons can hang onto their blocks, hoping to book all the time out and then fail to do so. Late-shows, last-minute cancellations and no-shows can also zap valuable time, and surgeons may over or underestimate the time needed for surgeries causing various inefficiencies. The solution to this is to try and understand the reasons why surgical block time scheduling fails and seek out suitable tools that can address the most pervasive problems.
How to improve block time utilization
In order to improve surgical block time utilization, you must be aware of the potential pitfalls that can derail your best efforts at efficient block utilization.
Here is a roundup of the most common issues:
1. The right people are not notified when blocks become available
In many practices, surgeons will be allocated a predictable block of time each week or month.
For example, they may have the OR at the local hospital for 6 hours every Tuesday and Thursday. As often happens in a busy practice — particularly those that rely on labor-intensive manual processes such as handwriting appointments in a paper calendar, or updating a computer calendar that is not accessible centrally — a surgeon may know that s/he he will be on vacation on a particular date, but poor communication and visibility means that this information will fail to filter down to other surgeons or surgical schedulers who could ensure that this released block time is reclaimed and utilized.
The practice of assigning blocks to specific surgeons raises an interesting question around block “ownership” which is poorly addressed in many practices. It is common across practices to consider each block as belonging to the surgeon whose name appears on the schedule. The logical thinking would thus be that if a block is released it is the responsibility of the nominated surgeon to find a replacement to take it over.
A more efficient way to do things would be to consider each block as the “property” of the practice. Upon release, it would be the job of the managers to offer the slot to other MDs in the practice. This would lead to less wastage of blocks and could also specifically benefit younger, less established MDs who sometimes struggle to get a foothold on the schedule.
One of the most common complaints made by younger surgeons is that they are unable to get sufficient OR time to build their practice. Taking the management of surgical block time utilization to the wider practice (rather than to individual MDs) would enable them to tackle this issue.
Much like a company’s shared Outlook calendar, a surgical management platform can provide everyone within the practice with a complete view of all the time blocks and to whom they are assigned. This transparent view of surgery block time across an entire practice makes the process of coordinating surgeon’s schedules and redistributing blocks of time where needed far more reliable and efficient. Such a platform would also make it easier for practices to transition to a “practice-owned” view of blocks and implement any relevant policies, such as one favoring block time allocations for younger surgeons.
2. Surgeons hang on to their time blocks
Surgeons are often reluctant to release unbooked time back into the pool as they don’t want to lose their block long-term. This means they often keep their full block until they are forced to release unused time according to the rules laid out in their organization’s block release policy. By this time, it may be too late for another surgeon in the practice to utilize the block and schedule surgeries.
This is especially true in the case of “flip rooms” where a particularly productive surgeon is allocated two ORs so they quickly jump from one to the other at the conclusion of each case. This can benefit a surgeon who wants to maximize his/her personal operating time but can lead to inefficiencies when all the time for both ORs cannot be used.
Surgical management platforms provide a master view of all time blocks for surgeons at the practice. In busy practices with many surgeons, real-time visibility into available block times is one of the best ways to ensure that all time-blocks are maximally utilized and that any released blocks are redistributed to other surgeons in the practice. This sort of platform allows schedulers to be ahead of the game and maximize surgery block time utilization.
3. Surgeons miscalculate case length needed
When surgeons either under- or overestimate the time needed to perform a procedure, the result can be an under or over-scheduled OR. According to OR Manager, surgeons often underestimate the time they need because they fail to take into account the time needed for patient induction, preparation, room setup, and/or clean-up, among other things. This can result in the allocation of too many surgeries than is feasible in a block of time. Imagine the frustration—not to mention the damage to the practice’s reputation— if a patient has fasted all day only to be told that they cannot have their surgery. In an overscheduled OR, surgeons can end up doing 12 straight hours of surgery which is clearly not ideal – especially for the final patient of the day!
On the other hand, surgeons sometimes overestimate the time a procedure should take, scheduling fewer surgeries than they could have done and underutilizing the OR. Sometimes errors in time estimation can be attributed to the records the practice keeps. For example, a hip replacement surgery might be recorded in the system under a certain code which dictates a required OR time of 1.5 hours, when the actual time needed is 2 hours.
Scheduling teams manage case lengths based on procedure type and facility. After performing surgeries, surgeons should report back to their scheduling team regarding case time so that these timings can be tracked, managed and adjusted for future scheduling of the same code. Of course, these estimations should incorporate time needed for preoperative and post-operative processes.
A surgical management platform helps practices keep a handle on this information as it comes in. When schedulers receive updated feedback from surgeons regarding case length, they can update the case length into the template associated with that procedure ensuring that future scheduling more accurately reflects reality.
4. Surgeries don’t start on time, or there are “no-shows”
A late start to surgery is a practice’s nightmare, creating a cascade of late surgeries in its wake. In order to begin on time, all parties involved in the surgery must be present — including the patient, surgeon, assistants, anesthesiologist, and nurses. The necessary equipment must also have been ordered in advance and be present in the OR. A failure at any of these levels will throw the schedule out of whack. Other common scenarios that throw surgical schedules off are last-minute cancellations and no-shows.
While it’s not possible to avoid every late or no-show, and sometimes mistakes do happen when ordering equipment or booking personnel, many of these inefficiencies can be avoided by using technology. Surgical management platforms automate all of the moving parts and make things run more efficiently. There are pre-surgery checklists that are adhered to and ensure all is set in the lead up to surgery.
Customized patient letters can be generated out of the system, sharing all information about the procedure in an organized and clear way so that patients know exactly where to be and when on the surgery date. If cancellations or schedule changes are made in advance, a list of patients waiting to “move up” in the schedule can easily be accessed so they can be slotted in and ensure efficient block utilization.
Additionally, automated patient messaging or alert systems can be activated to ensure that the right people are notified at the right time of any developments in their surgical scheduling.
How a surgical management platform helps block utilization
While the process of surgical block scheduling was designed to solve inefficiencies in the allocation of OR time and make surgical businesses more profitable, the outdated procedures and technologies used in many surgical businesses mean that the full benefits of block scheduling are often not realized. Surgical Management platforms like Surgimate provide practices with many benefits that ensure block time is maximized. Surgimate provides a full view of all surgery block times, making allocation and reallocation of time blocks totally seamless and transparent and ensuring that newly-released blocks of time do not slip by unnoticed.
Practices can also use their surgical management platform to automate many of the processes leading up to the surgery, such as
- ordering equipment,
- ensuring clearances are obtained and
- giving the patient has clear pre-op instructions.
This can reduce many of the mishaps that cause surgery to be postponed, canceled or run overtime. Managers can also use a platform like Surgimate to run surgical data reports in real-time —such as surgical volume by facility, cancellation reasons and block time utilization —and apply this information to refine processes.
Finally, managers and senior leadership will be able to dip into the data and analytics provided with their management platform and use it to track KPIs and devise better processes to run their surgical businesses more effectively and profitably.
Find out more about Surgimate to help your practice run more efficiently by maximizing block utilization.