7 Guiding Tenets for Optimizing Perioperative Efficiency During the COVID-19 Recovery

By Shawn Sefton

The operating room is the most lucrative area of a hospital’s business. Data shows perioperative services often contribute as much as 68% of a hospital’s revenue and up to 60% of a hospital’s operating margin. This is why when the COVD-19 pandemic erupted this spring, healthcare organizations and providers took a painful financial hit. Some organizations were estimated to lose $50 billion a month, largely from forgone surgeries and procedures. 

According to Dan Towarnicke, Vice President, Perioperative Services at University Hospitals (UH) in Cleveland, in just the first three months of the pandemic, UH had more than 4,000 surgical procedures, plus an additional 2,000 cath lab and endoscopy procedures postponed. Across University Hospitals‘ network , which comprises 15 operating locations, the health system was down to about 30% of the procedures it would normally do.

While most providers, including UH, have begun scheduling some level of elective procedures again, the pent-up patient demand for surgical and procedural care is immense. Health care organizations, physicians, and nurses must manage this demand against multiple constraints. These include internal issues such as case prioritization given the significant backlog of cases to assess, prioritize and reschedule; the ability to monitor and predict future demand; workforce furloughs that limited the availability and capacity of departments; and supply availability and inconsistent supply chain that quickly became decimated. External constraints include not only the continued prevalence of COVID-19 in certain regions and changing state and local guidelines, but patient concerns due to loss of income or insurance coverage or a reluctance to enter hospitals during a pandemic. 

For instance, as UH managed its COVID-19 surgical reopening, the health system focused on trying to understand the equivalent room time associated what the 6,000 surgical and procedural cases that were canceled. For UH to effectively manage its schedules, staff, added blocks, weekend schedule, and extended shifts, they’ve had to dig into their performance measurement tools to quantify, by service line and location, how much OR time will be needed to make up for this demand. UH also analyzed which patients were ready to come back from a financial clearance standpoint, and which ones still had a valid authorization or didn’t require insurance authorization from Medicare, Medicaid, etc. 

After reviewing several industry guidelines and working with partner hospitals, I’ve summarized the findings and developed seven guiding tenets for hospitals and health systems to managing their surgical services during the COVID-19 recovery and beyond. 

Establish COVID-19 Governance

Hospitals must provide defined, transparent, and responsive oversight of their COVID-19 Perioperative Performance Plan, as well as guidance to the multidisciplinary task force implementing the plan. The committee should establish their governance based on the development and implementation of guidelines; ensure guidelines are transparent and equitable for the system in consideration of rapidly changing local and regional issues; ensure the committee is multidisciplinary in nature and includes members of the C-suite, surgery, anesthesia, nursing team leaders, and other departments as necessary.

Develop Guiding Principles for Case Prioritization

Guiding principles for case prioritization can be shared with surgical offices to assist them in organizing and planning their backlog as well as providing support to frontline staff (OR schedulers, etc.) when deciding what cases get on the day’s schedule. Items for consideration include Medical Necessity Time Sensitive Procedure (MeNTS*); case acuity; likelihood and impact of condition worsening with delayed surgical treatment; logistical feasibility (facility resources, community impacts); patient willingness to continue with surgical treatment (e.g., how safe they feel going to the hospital, do they still have health insurance?); and more.

Design an Operating Model

Designing an operating model assists the organization in addressing the current state and in looking forward to set priorities and goals and operationalize plans. Processes will need to be iterative in a fluid environment and continually consider new information, resource availability, simultaneous organic growth, and tracking backlogged cases to completion.

Establish a Multidisciplinary Task Force

To operationalize and adhere to the COVID-19 Perioperative Plan with set goals and targets, the task force should review conflicts and provide recommendations to the COVID-19 governance team. Membership of this task force should include representatives from surgery, anesthesia, hospitalist groups, perioperative nursing, inpatient nursing, supply chain, sterile processing organizational operations, perioperative business operations and other areas as organizationally indicated (e.g., Radiology, Lab, Pharmacy, Pathology).

Develop a Mixed Media Communications Plan

With surgeons, office staff, and patients not always available at their office locations or phones, it’s crucial to have multiple ways of sharing information between key participants and to have one agreed upon source of truth. Hospital leaders should include expectations around case prioritization, the operating model, and other pertinent information for bringing patients back into the OR. The plan should also include operational information such as allocated block time, open time, and released time that is available for surgeons and their offices to fill according to the case prioritization guidelines. 

Initiate a Daily Huddle Schedule

Hospital leaders should proactively manage current and future operating room

schedules to optimize capacity and predictability. This includes establishing a multi-disciplinary huddle to efficiently and effectively optimize resources and capacity, review the current day’s OR schedule, understand how rooms are running in real-time, and review the OR schedule 3-5 days in advance, among other priorities.

Create, Track, and Report Performance Indicators

Identifying, tracking, and reporting metrics and performance indicators ensures focus is kept on critical issues as well as providing insight into which recovery methods are working and which ones are not. It also provides documentation to reference for future instances of massive disruption. Hospital leaders should establish a pre-COVID-19

baseline for all typical industry KPIs (e.g., block utilization, OR turnaround time, surgical case on-time starts, delays, cancellations), prioritize backlogged cases, monitor organic growth vs. backlog volume, calculate block utilization, create additional operating hours and utilization, (if needed) and determine labor use.

Today, UH has returned to near budget numbers for volume. Activity is stronger on the inpatient side, with a small percentage of outpatient volume still reluctant to come back. Some service lines are bouncing back quicker than others and to facilitate the extra hours, UH has been opening block time on Saturdays. Staffing is still facing the repercussions of COVID-19, including dealing with reluctance to return to work and childcare issues.  

COVID-19 is a dynamic situation that requires strong governance and communication plans across all perioperative stakeholders. Traditional methods used to manage the

perioperative department may not be effective, necessitating the need to discuss and consider the impact of all options. The biggest key for health systems in reopening and ramping up activities, across the enterprise, will be visibility, transparency, and trust. 

Fortunately, advanced technology platforms are emerging that provide actionable insights to help perioperative managers and surgical leaders once again optimize operating rooms to increase revenues and ensure patients are receiving timely care. These technology platforms use artificial intelligence and machine learning to help hospitals uncover hidden OR capacity, increase access to the OR schedule, make structural block allocation changes, improve optimization, and predict schedule, staff, and inpatient bed capacity. The real-time data and metrics these solutions deliver allow leaders to make effective decisions during fluid and variable times. They also aid in the development of prescriptive actions, workflow management, and streamlined communications that enable health systems to achieve and sustain peak operational performance. Advanced workflow and analytics systems are crucial to improving operational efficiency, helping leaders manage through COVID-19 and emerging from it more optimized than ever.

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Shawn Sefton is VP, Client Services and CNO for Hospital IQ, the leading provider of hospital operations management software solutions. Shawn is a Registered Nurse and has more than 30 years combined clinical and consulting experience.