ot utilization review
TRANSCRIPT
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OT1 UTILIZATION REVIEW AT
XYZ HOSPTAL
BY DR.SUGATA PYNEBHMS, MHATISS,MUMBAI2012-14
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OBJECTIVES
• To find out the capacity utilization and actual utilization time of OT1 .
• To find out the reasons for the gap in available working time and utilization time of the OT (if any).
• To find out the type of surgeries that take place in the OT and analyze the related information.
• To suggest measures to improve the utilization of the OT.
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METHODOLOGY
• A retrospective study was done of OT1.
• An observational study of the workflow of the OT was done from 01.09.2013 to 21.09.2013 using non-participation approach.
• Data Analysis: Data was analysed with the help of MS-Excel.
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Working of OT
• The OT works from 8 am to 4 pm Monday to Saturday.
• 8 hours daily
• 10 minutes between surgeries for cleaning and restoration
• Sunday : repair and maintainence.
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Patient admitted on previous evening of scheduled surgery date and prepared for
surgery next morning.
Anaesthesist and surgeon arrives.
Patient called from ward 15 minutes before scheduled surgery time. Ward boys of respective ward takes the patient to OT
Immediately after surgery patient taken out of OT and kept in recovery room till
patient gains consciousness
After gaining consciousness, patient sent to ward
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JAN
FEB
MAR
APR
MAY
JUN
JULAUG
SEPOCT
NOV
DEC
days of month 31 29 31 30 31 30 31 31 30 31 30 31
working days 25 25 25 24 26 26 26 25 25 27 25 25
0
5
10
15
20
25
30
35
days of month
working days
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JAN FEBMAR
APR MAY JUN JUL AUG SEP OCTNOV
DEC
Series 1 86 96 112 115 122 135 145 98 83 103 76 98
0
20
40
60
80
100
120
140
160
NO. OF HOURS OF OT UTILIZATION
Series 1
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JAN FEBMAR
APR
MAY
JUN JULAUG
SEPOCT
NOV
DEC
HOURS UTILIZED 86 96 112 115 122 135 145 98 83 103 76 98
AVAILABLE HOURS 196 196 196 188 204 204 204 196 196 212 196 196
0
50
100
150
200
250
HOURS UTILIZED
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JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
PERCENTAGE UTILIZATION
43.9 49.0 57.2 61.1 59.9 66.3 71.2 50.0 42.3 48.6 38.8 50.0
0
10
20
30
40
50
60
70
80PERCENTAGE UTILIZATION
PERCENTAGE UTILIZATION
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UTILIZATION OF OT1 IN 2012
• Total hours available = 2380.9 hours
• Total hours utilized = 1269 hours
• Percentage utilization = 53.29%
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JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Series 1 38 37 37 33 51 40 34 35 30 40 29 39
0
10
20
30
40
50
60
TOTAL SURGERIES
TOTAL = 443AVG = 37/ month
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CARDIAC
ORTHO ENT EYEUROLO
GYREPRODUCTIVE
OTHERS
NUMBER 55 320 20 12 8 3 25
0
50
100
150
200
250
300
350
Axi
s Ti
tle
NUMBER
SURGERY NUMBERS BY SPECIALITIES
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12%
73%
4%
3%2%
6%
0%
PERCENTAGE BREAKUP OF SURGERIES
CARDIAC
ORTHO
ENT
EYE
UROLOGY
OTHERS
REPRODUCTIVE
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34%
19%8%
8%
31%
BREAK UP OF ORTHO SURGERIES
SINGLE TKR
BIL. TKR
ACL RECONSTRUCTION
ARTHOSCOPY
OTHERS (THR, ORIF, K-WIRE, SHOULDER REPAIR, PLATING
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78%
5%
5%
2%2%
4% 4%
BREAKUP OF CARDIAC SURGERIES
CABG
AVR
ASD CLOSURE
PACEMAKER BATTERY REPLACEMENT
HICKMAN CATHETER INSERTION
THORACOSCOPY
MVR
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0
1
2
3
4
5
6
7
8
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
CABG
6 1 4 7 1 4 5 3 1 4 3 4
AVG = 3.5TOTAL = 43AVG TIME = 3-12 hrs.
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0
5
10
15
20
25
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
SINGLE SIDED TKR
2 20 11 6 10 8 11 10 5 11 9 7
TOTAL = 110AVG = 9
AVG TIME:LT TKR= 2.56 hrsRT TKR = 2.66 hrs
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0
1
2
3
4
5
6
7
8
9
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
BILATERAL TKR
6 1 8 6 5 7 7 3 5 4 4 6
TOTAL = 62AVG = 5
AVG TIME = 4.6 hrs
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0
1
2
3
4
5
6
7
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
COCHLEAR IMPLANT
3 2 0 0 6 2 0 1 0 1 3 0
TOTAL = 18AVG = 1.5
AVG TIME = 2.24 hrs
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0
1
2
3
4
5
6
7
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
ACL RECONSTRUCTION
5 0 0 0 4 0 0 6 0 2 2 6
TOTAL = 25AVG = 2
AVG TIME = 1.26 hrs
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0
1
2
3
4
5
6
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
KNEE ARTHOSCOPY
0 4 3 1 2 0 0 1 5 0 4 4
TOTAL = 24AVG = 2
AVG TIME = 1.3 hrs
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JAN
FEB
MAR
APR
MAY
JUN
JULAUG
SEP
OCT
NOV
DEC
LATER TO 8 AM 16 17 15 16 18 13 19 15 9 21 15 12
WORKING DAYS 25 25 25 24 26 26 26 25 25 27 25 25
0
5
10
15
20
25
30
LATER TO 8 AM
WORKING DAYS
TOTAL = 186AVG = 15.5/month
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0
10
20
30
40
50
60
70
80
90
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
PERCENTAGE
PERCENTAGE
PERCENTAGE OF CASES STARTING AFTER 8 AM
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AFTER 8 A.M START
8.15 AM TO 8.30 AM
83 CASES
8.45 AM TO 9.45 AM
48 CASES
10 AM TO 12 AM
42 CASES
AFTER 12.30 PM
17 CASES
@ 8 AM= 48 CASES
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24 CASES STARTED
BEFORE 8 A.M
6 AM
1 CASE
7 A.M
4 CASES
7.15 AM TO 7.45 AM
19 CASES
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JAN FEBMAR
APR MAY JUN JUL AUG SEP OCT NOV DEC
NO. OF SURGERIES 38 37 37 33 51 40 34 35 30 40 29 39
AFTER 4 3 7 8 7 8 9 11 6 6 6 3 9
0
10
20
30
40
50
60
SURGERIES AFTER 4
TOTAL = 83AVG = 7/month
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0
5
10
15
20
25
30
35
JAN
FEB
MA
R
AP
R
MA
Y
JUN
JUL
AU
G
SEP
OC
T
NO
V
DEC
PERCENTAGE
PERCENTAGE
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UPTO 4.30 PM
UPTO 5 PM
UPTO 5.30 PM
UPTO 6 PM
AFTER 6 PM
NUMBER OF SURGERIES 10 15 16 12 30
0
5
10
15
20
25
30
35
NUMBER OF SURGERIES AFTER 4 PM
NUMBER OF SURGERIES
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• Out of 304 starts, 48 starts (15.8%) were at 8 am. Rest were either delayed or before 8 am as shown previously
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JAN FEB MARAPR MAY JUN JUL AUG SEP OCTNOV DEC
NO SURGERY DAYS 4 3 3 2 1 5 4 3 6 2 7 3
0
1
2
3
4
5
6
7
8
NO SURGERY DAYSNO SURGERY DAYS
TOTAL = 43 DAYSAVG = 3.6 DAYS/MONTH
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FINDINGS OF 2012
• Underutilization of OT1.
• The hospital whose forte is cardiac surgery does more ortho surgeries.
• A good percentage of surgeries occur beyond the schedule hours [8 AM TO 4 PM].
• Around 1 and ½ months out of 12 months has been wasted.
• Delay of start of OT due to late arrival of both doctors and patients
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Utilization from Jan 2013-June 2013
• Total available hours = 1183 hours
• Total utilized hours = 556 hours
• Percentage utilization = 47%
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The not-so-bright current picture
The following observations were made during the OT study between Sept 1 to Sept 21.
Available hours = 133.2 hours
Utilized hours = 56.3 hours
Utilization = 42.26%
Cancelled surgeries = 3
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Total surgeries conducted = 19.
Number of surgeries conducted per day is 0.90 as compared to 1.23 in 2012.
14 (73.6%) ortho surgeries as compared to 73% in 2012.
3 (15.7%) cardiac surgeries as compared to 12% in 2012.
2 (10.5%) ENT surgeries as compared to 4% in 2012.
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DELAY IN SURGERIES
SCHEDULED DELAY
4 CASES
NON SCHEDULED
DELAY
10 CASES
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DATE SURGERY NO. DELAY IN START REASON
3.09.2013 1. TKR 90 MIN LATE ARRIVAL OF PATIENT
2. TKR 30 MIN LATE ARRIVAL OF PATIENT
4.09.2013 1. TKR 45 MIN LATE ARRIVAL OF PATIENT
6.09.2013 1. COCHLEAR IMPLANT
30 MIN LATE ARRIVAL OF PATIENT
2. CANCELLED
10.09.2013 1. COCHLEAR IMPLANT
30 MIN LATE ARRIVAL OF PATIENT
2. CANCELLED
14.09.2013 1. BHP 60 MIN LATE ARRIVAL OF SURGEON
2. CANCELLED
16.09.2013 1.THR 30 MIN LATE ARRIVAL OF PATIENT
17.09.2013 1.TKR 45 MIN LATE ARRIVAL OFPATIENT
18.09.2013 1. ASD CLOSURE 30 MIN LATE ARRIVAL OF SURGEON
20.09.2013 1. TKR 30 MIN LATE ARRIVAL OF SURGEON
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Patient delays : 7 out of 19 surgeries ( 2 ENT, 3 TKR surgeries) due to improper arrival of patients. Average delay = 43 minutes. Highest delay = 90 minutes. Lowest delay = 15 minutes
Doctor delays :3 out of 19 surgeries were delayed due to late arrival of doctors. Average delay time = 40 minutes.
Bilateral TKR scheduled for 3 hours but goes on for 5 hours. Average bilateral TKR surgery time = 4.6 hours.
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RECOMMENDATIONS• Reduce the incidence of surgeries before 8 a.m and
after 4 p.m to reduce the load on the nurses and avoiding overtime payments:
The hospital OT already suffers from the problem of shortage of nursing staff. To add to the problem the nurses available are distributed before and beyond the schedule hours to tackle the surgeries occuring at non-schedule hours. Instead if all surgeries are scheduled within the schedule hours, all the available nursing staff can be utilized at the same time. Also overtime remuneration can be avoided.
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• To reverse the trend of less cardiac surgeries in a cardiac centric hospital.
• Reduce the number of no surgery days or give offs to nurses and ward boys on those days.
• Follow up in the following years to keep track of OT utilization and other related data.
• It has been found that mostly ENT surgery patients come to the hospital in the same day of surgery sometimes exactly at the time when the surgery is scheduled or much later to the scheduled time. There is some time required by the nurses to prepare him/her for the surgery and to complete the necessary paper works. This results in loss of precious OT time. Adequate steps must be taken to prevent this.
• Design a marketing program to attract more doctors and patients.
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