Operating room leaders and clinicians work very hard and are focused on the care of the patient’s well-being and safety. Most operating room leaders are not trained to be IT Systems experts and depend on IT department support staff that are not intimately familiar how a surgical department operates.
Your surgical department’s day to day operations depend heavily on your Surgical Information Management System (SIMS) receiving ongoing maintenance to keep databases current. The COVID-19 pandemic has forced hospitals and ASC’s to postpone elective surgical cases, resulting in a devastating financial impact on the top line of every facility in the US. Now that normal surgical operations are resuming one of the issues operating room leaders will be faced with 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 exactly how well the databases in the SIMS are kept up to date? Now may be a very good 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 on a daily basis, two the of most important databases used to manage the department are the Master Procedure File and the Surgeon Preference Card Library. Chances are that if you were involved in the implementation process, you focused on documentation content and workflows. Large vendors are under pressure to finish implementation projects on tight timelines and with the directive to hold down costs or they are on a fix cost implementation contract. It is possible that the importance of the underlying databases the OR system uses for running the OR were not emphasized. 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 cleaned-up Preference Card library prior to uploaded or was the existing utilized?
- Did a Preference Card content reviewed take place to validate procedure length / set up / clean up times to ensure the 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 have an issue that is impacting the ability to accurately manage the surgical department. Allow me to explain.
Many hospitals that have not standardized the Master Procedure File (MPF) often have duplicate or multiple procedures with differing procedural names, that all correlates back to a single CPT-4 code. If you have a system administrator or Perioperative Business Manager routinely running reports, unless they know all the naming variations of the procedures listed in the MPF, your information system will often not pull data from the database accurately. Without the completeness of data, a number of important parameters needed to effectivity assess the operating room function will be flawed.
These can include, but not limited to:
- Inaccurate procedure volumes
- Case costing errors
- Inconsistent documentation and quality assessments
- Billing and charging inaccuracies
- Associating the incorrect surgeon specific preference card to a procedure
Many hospitals are beginning to discover without this information, they are flying blind when trying to manage the operating room in a post COVID-19 environment, where having a well function operating room will be so critical to a hospitals overall financial success and security.
The other very important database that is required to ensure 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 operate within or touch the operating room. Chief among these groups are the Surgeons, Materials Management and the Service Line leaders.
Another aspect of the preference card clean-up is if you plan to improve throughput, you need to measure clean up start to clean up end and link this to the next procedure case set up start time. The time between clean up end and set up start time for the following procedure is called Idle Time. If you can successfully shrink the Idle Time amount, there are more available schedulable minutes for additional cases.
Another consideration is what does the scheduling system use for turn-over time calculation? Is the set up and clean up combined? Are they tracked as separate times? 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? Or, do you let the schedulers free text a set up and clean up? This is typically one of those hidden areas in a typical operating room day where time disappears. In most SIMS, there is no easy way to gather this information in a tool, but if you can understand and expose the methodology and thought process used during the set-up of the SIMS, it would show the obvious flaws hiding from the leadership.
Before beginning such an important overall project to update the MPF and preference cards databases is the creation of a governance structure to develop the plan and process to of how best to manage the project and keep these databases current. As internal hospital resources are often limited and the expertise requires an understanding of OR processes, the governance members should include clinical supply chain, RCM, Information Technology and operating room clinical knowledge, an updating project such as this can be complex.
The underlying goal of updating the MPF and Preference Card databases is to provide accurate reporting needed to manage the operating room and the financial impact. These two databases provide source data for:
- Surgical procedure volumes
- Specific room performance information such as-On Time Starts, Block Utilization, Add On Cases
- Specific surgeon information
- Service line performance
- Overall financial performance
The COVID pandemic has clearly shown 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 ensure accurate reporting and result in improved operating room throughput, to help elevate the procedure backlog created by the COVID pandemic and help administrators and operating room leadership to address traditional operational inefficiencies.