Surgery is a big moneymaker for hospitals. In fact, a recent survey conducted by healthcare staffing firm Merritt Hawkins found that the top four revenue-generating physicians for healthcare organizations were all surgeons, with cardiovascular surgery topping the list at nearly $3.7 million in annual revenue per doctor.
Yet at the same time, operating rooms and surgical services are enormously costly for hospitals. A 2018 study of California hospitals conducted by UCLA researchers found that each minute in the operating room (OR) costs at least $36, with about two-thirds of those costs going to labor.
Why can’t hospitals just increase what they charge to make up for those costs? It’s not that easy. Considering more than half of a hospital’s revenue comes from the Centers for Medicare and Medicaid Services (CMS) and commercial health insurers are increasingly consolidating, the negotiating room for hospitals is narrowing — if they have any power in their market at all.
On top of that, hospitals and health systems are entering more value-based care payment programs with their top payers, including Medicare — which, in part, reimburses them based on cost control. For example, if the hospital can keep the costs of a total hip replacement surgery to less than $30,000, it can keep most of whatever is remaining.
Moving Bodies Create Delays
This payment situation leaves hospitals in a precarious situation — one they have little control over. What they can control, on the other hand, is the operations of the operating rooms. Yet a study of three high-volume urban hospitals found that 88% of the first surgery cases of the day were delayed.
The reason? People. Of the causes documented, researchers found physicians, patients and clinical staff were the top delay contributors. However, in 60% of the delays, there was no cause recorded, which makes it difficult — if not impossible — to identify and fix the processes that are leading to late starts and inefficiencies.
Late starts in the first case of the day are only part of the challenge. Hospitals also face slow OR turnaround times because teams are scattered while environmental services, who clean the rooms, may not be promptly notified. These delays compound throughout the day as providers lose sight of patients who may be moved to a different area of the hospital for additional blood tests or imaging studies.
Trying to communicate with care teams is also inefficient. Although more than 75% of physicians use mobile health in their practices, looping in the entire OR team is more difficult because there are various members, roles and communications equipment as well as HIPAA concerns with mobile devices.
Tracking Location Alone Insufficient
To eliminate these delays, more healthcare organizations are implementing real-time location system (RTLS) technology. The technology, in fact, is so popular that it is expected to grow from $3.19 billion in 2018 and to $8.79 billion by 2023. Most RTLS technology works by placing a radio-frequency identification or Wi-Fi-enabled sensor in a bracelet or a badge worn by patients, providers and equipment. The sensors ping receivers installed around the hospital as people and devices move, and those signals are sent to a software platform that offers visual tracking of sensors around the facility.
RTLS is enormously helpful, but real-time location data only helps hospitals in the moment, not for long-term improvement. It’s also not helpful to just know where a patient or a provider is if you don’t have an effective way to communicate with the rest of the care team about the patient’s progress through the care episode.
AI And Integration Essential
The entire healthcare industry is grappling with IT interoperability, trying to share electronic health records (EHRs) between different providers and organizations. The same struggle is even occurring inside individual facilities. Different systems — such as RTLS, for example — often can’t communicate with clinical communications or the EHRs.
Integrating these technologies, however, is essential to eliminate late starts and delays in operating rooms. The RTLS should automatically notify providers about patient movements to the next stage of care and alleviate busy providers from needing to manually text each other fairly standardized messages.
Using artificial intelligence and machine learning technologies, such as integrated platforms, should take data from the RTLS, EHRs, scheduling and other systems to identify the causes of delays so workflows and patient flows can be adjusted. The technology should offer predictions about expected OR traffic and case lengths throughout the day to give managers insight about staffing and equipment needs. Patients and families, too, would be more satisfied when they won’t have to wait unnecessarily for their surgery.
To improve their OR turnaround times, healthcare organizations should first identify what in the workflows is causing inefficiencies and slowing their care teams, such as manual data entry and slower forms of communication between members. Another area to investigate is how reports can provide greater insights into how long cases are taking and the level of staffing that’s been required. Addressing ways to monitor critical movements of physical equipment — such as surgical beds being moved in and out of rooms — can also cut down on unnecessary, wasted time.
After those assessments are made, an eye can be given to how technology — including AI and machine learning — can help and where to include RFID tags and RTLS to improve the OR’s processes and workflows. The organization will reap greater rewards on the investments in the ORs technology because it had taken the time to review team-member shortcomings and where the greatest return on the investment would come from.
Considering surgeries are among their highest-revenue generating services, these healthcare organizations need to confront how they can improve this department’s efficiency and productivity. Knowing the location of people is only part of the equation. Analyzing location data to find out where they go, what’s causing delays and unclogging the slowdowns are the other, arguably much more important, half.
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