Robert Wood Johnson University Hospital in New Brunswick, N.J. went live with data analytics software in its surgical suite in early 2012. After the second quarter, Amy Smith, vice president of perioperative services, ran her first quarterly report analyzing staffing and operating room use.
The report showed that too many staff members were scheduled early each day and not enough in the mid-afternoon. After rearranging schedules the hospital saved $500,000 in overtime during the last three quarters of the year. “It was one of those ‘Ah-Ha!’ moments,” Smith recalls.
With the analytics software from the hospital’s core perioperative vendor Surgical Information Systems, Smith is tracking operating room turnaround times, on-time case starts, overtime and OR use. With the information Smith can discover where bottlenecks happen that can shrink operating room use, cutting into the biggest revenue drivers for hospitals.
Data is fed into the analytics dashboard from the SIS perioperative system. For each surgery she knows how long it takes to prep the patient, when the first incision was made, actual time in surgery – from the time when the patient is wheeled in to when he’s wheeled out-and how long it takes to clean the room and prep it for the next patient. If cases don’t start on time, Smith knows the reason. It could be that the paperwork was incomplete or the surgeon was late, or blood wasn’t cross-matched before surgery, housekeeping wasn’t available, or the surgeon didn’t block enough time for the procedure.
She found that the failure to book adequate time was a major cause of scheduling snafus. An analysis of 1,300 procedures found that 500 cases ran over the expected time. Smith also knows who are the chronically late surgeons and is working with them to eliminate that issue.
Understanding and preventing logjams increased case volume in the surgical department and added $3.5 million to the bottom line in 2012, Smith says. “With analytics I realized we had capacity and where it was, and could open block times and increase volume,” she says.
A starting point
In many surgical suites, metrics such as time stamps for certain processes, reminders such as re-dosing antibiotics, estimates of blood loss and equipment tracking are written manually on whiteboards after being pulled from the perioperative system. Staff monitor vital signs through the anesthesia system displayed on a monitor.
Except for vital signs, most of the information is not real-time and may not be accurate because of errors between pulling the data and writing it down.
Many software vendors in recent years have introduced dashboard technology that pulls data from the surgical information system and monitors, organizes and displays the information on a screen. Jeff Robbins, CEO at dashboard vendor LiveData Inc. in Cambridge, Mass., says the dashboards can provide dynamic reports of key performance indicators that can be refreshed during the course of treatment, and can later generate reports to show how a surgical unit performed during the past week or month. Dashboards also can help with adopting analytics, and some include basic analysis capabilities.
Dashboards also can integrate safety into workflow, such as automating a safe surgery checklist, an automated time-out to verify that the staff is operating on the correct patient, correct body part, using the proper procedure before an operation begins. Integrating dashboards with real-time location systems technology (see sidebar, next page) can enable administrators to use the physical location of patients and caregivers as objective data when trying to understand bottlenecks.
Some surgical information system vendors, either organically or through third parties, have added data analytics to their product suite to better collect, understand and use data generated in the surgical unit. LiveData, for instance, uses analytics and data presentation technology from Tableau Software.
A dashboard can produce a report showing that 20 percent of surgical cases are running late, but analytics enables an administrator to query an analysis of data and generate a new report that examines the reasons those cases run late, says Smith of Robert Wood Johnson hospital.
Analytics is like peeling an onion and drilling down until answers are found, Smith explains. “Dashboards report statistics, but analytics pull in different data types to give reasons behind the data and provide useful information,” she says. “It puts two pieces together so you can see the picture.”
Dashboards provide information that administrators want to review because visual tools have a pre-set list of metrics to test, says Randy Thomas, a health analytics consultant at Encore Health Resources. “Those metrics tell you where you are, but they don’t necessarily tell you what to do about it. A dashboard will uncover a problem with antibiotics, but analytics helps you identify the problem and its causes,” Thomas says.
Few hospitals, though, deploy what could be considered “real” analytics in the surgical suite today because of high costs, although that soon could change, Thomas says. Analytics will enable specific queries of data to uncover what’s happening with supply costs-surgery drives 40 percent of a hospital’s costs-and with clinical and financial decisions.
As electronic health records implementations wind down and pressure rises to use electronic measures to provide metrics on care, “this will be the leverage to start using data in the systems,” Thomas says.
Also, the bulk of EHR deployments will wrap in 2015, and providers will enter the later stages of meaningful use. “The primary focus after 2015 will be analytics,” she predicts.
For now, EHR installations and other I.T. upgrades can let providers determine how they want the data to be used, Thomas says. “Ensure you have the data you need for in-house use, payer contracts and regulatory compliance.” When upgrading to Stage 2, she suggests placing a few bets now. “Look beyond the hospital to incorporate patient self-reported data, and data from physician offices, home health and long-term care,” she says. “Have a logical plan of the data you will need and how to get it.”
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