Part of 4 of Access’s Improving the Economy of Surgical Services series
Have you ever heard the old adage, “Time is money”? When it comes to surgical delays, this is all too true for hospitals. In a perfect world, every procedure would take place precisely when it was supposed to. But unfortunately at many facilities, delayed operative procedures are a daily occurrence. One culprit cited in causing delays in 14% of operative cases was missing paper Informed Consents.
In a recent JAMA Surgery study, the authors write, “Missing consent forms at surgery can lead to delays in patient care, provider frustration, and patient anxiety.”
The study also indicates that much of the burden of obtaining consents falls on residents. “In many instances, the missing consent forms interfered with team rounds and resident educational activities,” the paper states.
The Fiscal Fallout from Delayed Operative Cases
All this extra work doesn’t just divert residents, nurses, attending physicians, surgical services and HIM staff from patient-centric tasks and waste their time, or undermine patient confidence. It also incurs fiscal costs that impact the bottom line. The writers of a 2007 paper entitled “Optimizing your Operating Room: Or, Why Large, Traditional Hospitals Don't Work” (Girotto, Koltz and Drugas) that was published in the International Journal of Surgery found that at one hospital, University of Rochester Medical Center URMC, each hour of unused operative time in the OR costs $3,600. That means that each lost minute cost $60.
As high as these numbers are, they don’t even include lost surgeon time or the necessary increase to account for 11 years of inflation from the original publish date until now. Over just a two-week period, URMC lost $90,720 in “first start” cases that were delayed or canceled. URMC has 20 operating rooms, so extrapolating those initial figures out to five days per week for 50 weeks represents 7,500 postponed or cancelled “first start” cases annually. So the total delay time in first start cases is 98,100 minutes annually, which equates to a loss of $5.9M.
Additional analysis from Administration of Perioperative Services in fall 2007 upped this time/value to $100/minute ($6,000 an hour), leading to a huge annual cost of $9.6M annually. And that’s just for the first operative case of each day. The lost revenue would be far greater if we took all the other procedures later in the day into account.
Here are a few other staggering statistics:
- At URMC, surgical delays led to the hospital exceeding its overtime budget by $960,000.
- Total overtime pay for nursing staff approached $1.4M, which is almost a 200 percent variance from the budget of $500,000.
- A Journal of Patient-Centered Research and Reviews paper found the average surgical delay across multiple hospitals was 24 minutes and that 88 percent of cases were delayed.
- Even if we took the lower per-minute cost of $60, this means the typical delayed case costs a hospital $1,440, which adds up very quickly over the course of a fiscal year.
The bottom line? The more cases a facility has, the bigger the overtime bill, the more time wasted, and the bigger the negative impact on patient care, service, and satisfaction.
Going back to the URMC case example, Girotto, Koltz, and Drugas suggest that reducing the average surgical delay by just 10 minutes could make a big difference, including one extra procedure being performed each day. That would gain back $30,000 per week, leading to an annual cost savings of $1.5 million. Even at a smaller hospital with less operative cases, creating such efficiency could greatly improve profitability and make it easier for the organization to plan and stick to realistic budgets.
Gaining Back Lost Time + Revenue
But how would a hospital surgical services department go about gaining back such lost time? How do you create a process that gathers complete, signed and dated consents as the rule, not the exception? The answer is actually simpler than you might imagine: by replacing paper consents with electronic forms that can be launched directly and seamlessly from within the EMR and completed via iPads and other mobile devices. With such a system, complete and current information could be obtained the first time every time, removing the need for patients to re-consent and eliminating the paper chase between administrative and clinical staff. A solution like Access Passport also extends patient electronic signature capture to the bedside.
Hospital users never have to leave Epic, Cerner, MEDITECH, or whatever EMR they work in daily, further improving productivity. In fact, they won’t even know that they’re using another application. While the technology cannot remove delays associated with patients or physician tardiness, anesthesia and certain other factors, it can eliminate those caused by missing or incomplete consents. And that could save face with patients, time for everyone involved, and millions of dollars for your hospital.
Check back next week for article five in our Improving the Economy of Surgical Services series.
Cox Bauer, Callie M., Danielle M. Greer, Kiley B. Vander Wyst, and Scott A. Kamelle. 2016. “First-Case Operating Room Delays: Patterns Across Urban Hospitals of a Single Health Care System.” Journal of Patient-Centered Research and Reviews 3 (3): 125–35.
Garonzik-Wang, Jacqueline M., Gabriel Brat, Jose H. Salazar, Andrew Dhanasopon, Anthony Lin, Adesola Akinkuotu, Andres O’Daly, et al. 2013. “Missing Consent Forms in the Preoperative Area: A Single-Center Assessment of the Scope of the Problem and Its Downstream Effects.” JAMA Surgery 148 (9): 886–89.