Real-Time Analytics Platform Helps University Hospitals Restart Elective Procedures
// By Jane Weber Brubaker //
Hitting the pause button on elective procedures has resulted in deep financial losses across all U.S. health systems, and they now face immense pressure to recover financially, as quickly as possible.
In Ohio, nonessential elective procedures stopped on March 18 and didn’t reopen until May 1. Even now, only elective procedures that do not require an overnight stay have restarted.
At University Hospitals (UH) in Cleveland, thousands of surgeries and procedures that were scheduled during the six-week period had to be canceled, according to Dan Towarnicke, vice president of perioperative services. “We had to postpone 4,000 surgeries and another 2,000 procedures such as cath (cardiac catherization) lab, EP [electrophysiology], or endo [endoscopy] procedures,” he says. Towarnicke estimates financial losses in the “tens of millions of dollars.”
Now that elective procedures have partially reopened, the challenge is getting those patients back into the schedule and managing the operating rooms (ORs) and labs for maximum efficiency. A machine learning platform UH adopted in late 2017 — Hospital IQ — is making it easier for the system to move forward.
Even during normal times, making the best use of costly resources like ORs and procedural areas (cath labs, endoscopy areas, interventional radiology areas) is difficult, and often the reason is lack of timely information about usage. One advantage the Hospital IQ platform provides is real-time information.
“It’s a data-driven platform that applies system-specific policies, machine learning, and other analytical methods to perioperative data in order to accurately forecast OR utilization and make recommendations to improve operational performance,” says Shawn Sefton, vice president of client operations at Hospital IQ, and former perioperative nurse executive.
Real-Time Access to Information Drives Improvements
Before UH implemented Hospital IQ in late 2017, it was difficult to get real-time analytical data on OR utilization. “We would download data into Excel files and our business analysts would make it usable,” says Towarnicke. “But the information was not timely. By the time we got the reports, it was too late to make any meaningful changes.”
Scheduling feeds data into the platform in real time, enabling the team to react to new information as situations change. The technology allows the perioperative team to visualize how operating room block time is being used, and identifies opportunities to better allocate time to surgeons. “Our block system was antiquated,” Towarnicke says. “We redid all blocks for our 42 ORs in our downtown campus and can now determine who should have priority, and which services.”
The platform gives the team the ability to track key metrics such as room utilization and turnover times. “It doesn’t happen overnight, but we’ve seen an improvement of 5 percent in room utilization, and we’ve been able to drive turnaround for ORs down from one hour to 40 minutes,” Towarnicke says.
Planning for Recovery During the Pandemic
Once Ohio shut down elective procedures, Towarnicke says that overnight the number of patients dropped from 420 to 120 — a 70 percent decrease. The platform captured data on canceled procedures by hospital, service line, and physician as well as the number of hours of OR time that had been canceled. This information helped the team plan for recovery once the shutdown of elective surgeries was lifted.
As UH begins to restart elective procedures, the experience it has built up using the platform is helping the system manage the backlog. “We were able to create work lists for surgeons to help them reconnect with patients,” Towarnicke says.
Hospital IQ’s “Surgeon Access” module has been key to making adjustments to blocks. The module “enables hospitals to better engage with surgeons to proactively identify hidden OR time and make it available to surgeons while eliminating the traditional back and forth with central scheduling. The result is increased surgical volume and OR utilization,” according to a 2019 press release.
Towarnicke explains, “A surgeon can release block time that they’re not using, and another surgeon can pick it up if needed, or request time that would otherwise go unused.”
Addressing the Backlog
UH is not prioritizing patients by service line but by patient need. “Our goal is for the patient to get the procedure done when it’s needed,” he says. To catch up, UH has extended the workday and kept ORs open on weekends. Towarnicke says, “We’re currently operating at 80 percent of normal.” Some patients are still cautious about rescheduling procedures, and inpatient elective surgeries have not restarted yet.
As health systems move quickly to get back to some semblance of normal operations and restore revenue streams from elective procedures, having transparency into a very fluid, rapidly changing situation is critical. “We know that operating rooms really are the revenue engine of most organizations, so this really helps them,” Sefton says.
“Hospital IQ has been tremendously helpful,” says Towarnicke. “Otherwise we’d be flying blind. With this platform, we have good data and are more confident in our decisions.”
Priorities for Recovery
Sefton identified a number of factors that could impact a health system’s ability to come back quickly:
- Availability of services such as radiology, blood bank, labs
- Availability of medications
- Bed capacity
- Personal protective equipment (PPE)
- Other equipment, supplies (anesthesia machines converted to ventilators)
- Patients whose insurance has lapsed
Guidelines for Reopening Surgical Services During COVID-19 Recovery – an e-book covering “7 Guiding Tenets for Operationalizing Reopening”
COVID-19 Regional Forecast – helps hospitals plan for increased patient demand due to the COVID-19 pandemic. Also tracks equipment inventory, provides auxiliary location visibility, flags patients with COVID-19, and forecasts census at the unit level for workforce planning.
Jane Weber Brubaker is executive editor of Plain-English Health Care, a division of Plain-English Media. She directs editorial content for eHealthcare Strategy & Trends and Strategic Health Care Marketing, and serves as chair of the eHealthcare Leadership Awards. Email her at firstname.lastname@example.org.