ot utilization review

OT1 UTILIZATION REVIEW AT

XYZ HOSPTAL

BY DR.SUGATA PYNEBHMS, MHATISS,MUMBAI2012-14

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.

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.

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.

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

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

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

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

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

UTILIZATION OF OT1 IN 2012

• Total hours available = 2380.9 hours

• Total hours utilized = 1269 hours

• Percentage utilization = 53.29%


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

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

12%

73%

4%

3%2%

6%

0%

PERCENTAGE BREAKUP OF SURGERIES

CARDIAC

ORTHO

ENT

EYE

UROLOGY

OTHERS

REPRODUCTIVE

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

78%

5%

5%

2%2%

4% 4%

BREAKUP OF CARDIAC SURGERIES

CABG

AVR

ASD CLOSURE

PACEMAKER BATTERY REPLACEMENT

HICKMAN CATHETER INSERTION

THORACOSCOPY

MVR

0

1

2

3

4

5

6

7

8


CABG

6 1 4 7 1 4 5 3 1 4 3 4

AVG = 3.5TOTAL = 43AVG TIME = 3-12 hrs.

0

5

10

15

20

25


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

0

1

2

3

4

5

6

7

8

9


BILATERAL TKR

6 1 8 6 5 7 7 3 5 4 4 6

TOTAL = 62AVG = 5

AVG TIME = 4.6 hrs

0

1

2

3

4

5

6

7


COCHLEAR IMPLANT

3 2 0 0 6 2 0 1 0 1 3 0

TOTAL = 18AVG = 1.5

AVG TIME = 2.24 hrs

0

1

2

3

4

5

6

7


ACL RECONSTRUCTION

5 0 0 0 4 0 0 6 0 2 2 6

TOTAL = 25AVG = 2

AVG TIME = 1.26 hrs

0

1

2

3

4

5

6


KNEE ARTHOSCOPY

0 4 3 1 2 0 0 1 5 0 4 4

TOTAL = 24AVG = 2

AVG TIME = 1.3 hrs

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

0

10

20

30

40

50

60

70

80

90


PERCENTAGE

PERCENTAGE

PERCENTAGE OF CASES STARTING AFTER 8 AM

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

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

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

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

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

• Out of 304 starts, 48 starts (15.8%) were at 8 am. Rest were either delayed or before 8 am as shown previously

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

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

Utilization from Jan 2013-June 2013

• Total available hours = 1183 hours

• Total utilized hours = 556 hours

• Percentage utilization = 47%

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

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.

DELAY IN SURGERIES

SCHEDULED DELAY

4 CASES

NON SCHEDULED

DELAY

10 CASES

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

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.

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.

• 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.

ot utilization review

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