Metrics In the Operating Room and Why They Matter | Part I
As a circulating nurse or surgical tech you hear about the metrics, but that’s about it. Either “you’re not meeting the metric” or (hopefully) a “good job on meeting the goal”. It wasn’t until my experience as a leader that I truly understood why these metrics actually do matter and why the leader should be motivating the team to meet them.
OR Metric #1 | Turnover Time
Turnover time isn’t JUST about getting the surgeon out for their tee time, it’s about efficiency. A standard goal for (same room) turnover is 28 minutes. That may seem like a long time, however there is a lot that happens during this time. The room must be cleaned, unnecessary equipment out, needed equipment in, sterile field set up, all the safety checks, anesthesia’s set up, and more. If you’re turning over between a tonsillectomy and another tonsillectomy— no big deal. However, if you’re turning over between a exploratory laparotomy and a
total knee replacement— that’s a different story. Get a routine down and stick to it, doing this leaves less room for errors. You’re providing prompt patient care— if you take ~45 minutes between your 4 turnovers, that’s nearly an additional hour that patient is waiting. That hungry, anxious, scared patient. This also leads to an irritated surgeon, which could lead to less desirable outcomes. And of course, revenue isn’t generated if there isn’t a patient in the room.
OR Metric #2 | Patient In Room to Cut Time
Again, this is an efficiency metric. The second the patient is checked as “in the room” is when their dollars start stacking up. If I can prevent my patient from an excess 20 minutes of OR time, I’m going to! That’s the most expensive time there is.
Story time. I was about to circulate an endoscopic facelift (first one I had seen, SO cool!) and the surgeon told me I’d need to get her hair parted a very specific way- this takes time. So, instead of getting the patient to the operating room and doing it there (costing significantly more money), I ran
over to pre-op and did it there. I was able to spend a little more (awake) time with the patient and her significant other, building a better rapport (those patient experience scores), this avoided any unnecessary hair shedding in the OR (hellllo infections), plus it’s a lot easier to do hair on someone awake and able to assist if necessary.
OR Metric #3 | Delays
Typically, only the first cases of the day are included in this metric as all following cases cannot have a definite start time. But, it goes along the same lines as turnover time— if the surgeon plans for roughly 6 hours of operating time in the 8 hour day and the OR team its it up with a delay in the morning, excessive turnover time, and excessive in room to cut time that 6 hours of operative time is stretched out too far. Why does this matter? What happens if there are more rooms running after 3 o’clock (typical normal end of elective case hours) and there
aren’t enough call teams to do the cases? You will likely be ‘voluntold’ you’ll have to finish your case (unless of course there are actual volunteers). Keep in mind, this applies to any time of delay (excessive turnover times, excess in room to cut time, etc.) That puts everyone in a tough spot. The nurse or scrub does NOT want to be forced into staying, but typically the charge nurse or leader also does NOT like this situation. As a leader, I took over for people many times at 3 o’clock when we didn’t have enough people to finish rooms. That is NOT the normal. As much as I loved getting to scrub in to cases or circulate rooms— it was taking time away from the other tasks I had to complete.
Something I was able to do as a leader to provide some “cushion” to the ‘too many cases not enough people’ situation was to offer an incentive. This was for anyone who worked past the end of their shift (unless they were on call). This incentive was in addition to call pay— I fought for the team to have an actual incentive not just a ‘here’s a pizza party’ type ordeal. Did it cost the hospital money? Yes. But, it would have been a bigger loss to have the cases done elsewhere because we didn’t have enough people.
There were so many months that I drilled down on the data and found that over 50% of the delays were due to the surgeon arriving late— you bet I reported that to senior leadership.
OR Metrics
There will always be fluctuations with these metrics— you may consistently meet some of these and then one month you’re way off target. Actually analyzing the data to see what happened is SO important. Were there excessive delays this past month? Why? Could it be that the patient’s were not using the restroom prior to surgery time and then when it’s go-time they ask to use the restroom? Okay— then lets add ‘pt. used restroom’ to the pre-op checklist and see if it makes a difference. Will that eliminate this from occurring? Of course not, but it may make a huge impact. You have to actually study all the data in order to find out what went ‘wrong’ but also to see what went right! Always celebrate the wins- no matter how many times you meet the metrics.
There are a handful of other metrics that are typically tracked, however they are not as controllable. In Part II, I will talk about volume, operative minutes, inpatient and outpatient procedures. What other metrics have you seen tracked?
