University of Michigan Hospital s Operating Room Utilization Analysis

Size: px

Start display at page:

Download "University of Michigan Hospital s Operating Room Utilization Analysis"

Claude Stevenson
5 years ago
Views:

1 University of Michigan Hospital s Operating Room Utilization Analysis by: Jim Caidwell Bernice Lin Grace Yee Client: Dr. Timothy Rutter Project Coordinator: Liz Othman, R.N. JOE 481-Senior Design Project University of Michigan, Ann Arbor June 1, 1993

2 n

3 University of Michigan Hospital s Operating Room Utilization Analysis I by: Jim Caidwell Bernice Lin Grace Yee Client: Dr. Timothy Rutter Project Coordinator: Liz Othman, RN. IOE 481-Senior Design Project University of Michigan, Ann Arbor June 1, 1993

4 TABLE OF CONTENTS EXECUTWE SUMviARY 1 C INTRODUCTION Background 2 APPROACH AND METHODOLOGY Data Collection 4 Simulation 5 Strengths and Limitations of Simulation Model 6 RESULTS ACSC 8 UMHOR 9 RECOMMENDATIONS 10 APPENDIX

EXECUTIVE SUMMARY The purpose of this project was to determine how moving outpatient surgeries from the ( University of Michigan Hospitals (UMH) operating rooms to an Ambulatory Care Surgical Center

This study centers around a computer simulation that models the UMH scheduling practices and calculates operating room utilization by service and by day.

5 EXECUTIVE SUMMARY The purpose of this project was to determine how moving outpatient surgeries from the ( University of Michigan Hospitals (UMH) operating rooms to an Ambulatory Care Surgical Center (ACSC) will affect the utilization of the UN fh operating room. This study centers around a computer simulation that models the UMH scheduling practices and calculates operating room utilization by service and by day. This simulation was constnicted for the present OR utilization analysis and the OR utilization under two scenarios involving the removal of some outpatient services. A simulation model was also written to determine the utilization of the ACSC under these two service removal scenarios. Both four room and six room capacities where modeled for the ACSC. The results of the simulation show that the present utilization of the UN IHOR including all services is 84.83%. Under scenario 1, the total utilization drops to 80.18% and drops again to 77.99% using scenario 2. The total utilization of the ACSC under scenario 1 is 95.81% for four operating rooms and % for six operating rooms. For scenario 2, the total utilization for four operating rooms is 10 and for six operating rooms, the utilization is 99.94%. A complete presentation of all the service utilization times per day for all scenarios (LTIVLHOR and ACSC) is provided in the Appendix. With a desired service utilization of 75.00% for the UMH, it is our conclusion that both scenarios would maintain desired utilization levels for the UMHOR while scenario 2 would clearly utilize the ACSC better than scenario 1. The simulation models should be used involving other service removal scenarios to determine the optimal utilization times for the TJMHOR and the ACSC. A complete guide to the simulation programs used in this study is provided in the User Manual supplement. Questions regarding model guidelines and assumptions, the simulation language used for the models, and logic behind the simulation models are addressed in the manual. The project team would like to recognize Dr. Tim Rutter, Liz Othman R.N., Scott Lovelace, Christopher Parin, and Alan Kalton for their invaluable help on this project.

6 INTRODUCTION n I. Background This project is a continuation of an ongoing study of the utilization of the UMH operating rooms. Previous studies conducted by University of Michigan Industrial and Operations Engineering students have focused on service surgery times, service turnaround times, and overall utilization of the operating rooms. The purpose of our project was to construct a simulation model that would closely model the UMF{ operating rooms and capture the utilization of each surgery service per day (Monday - Friday). After determining utilization by service and by day, we modified the model to determine how the UMII utilization is affected after removing certain outpatient services. In addition, a model was constructed to determine the utilization of the ACSC (with four and six operating rooms), based on the outpatient surgeries removed. Actual OR time of Advanced Scheduled Cases + Turnover Time Block Time Utilization = Block Assigned Time for Advanced Scheduled Cases The block time utilization as defined by the University of Michigan Hospital Operating Rooms Scheduling Department is: Block Time Utilization = Actual OR time of Advanced Scheduled Cases + Turnover Time Block Assigned Time for Advanced Scheduled Cases The services examined for this project and their abbreviations are as follows: 1. CARDIAC- Cardiac Surgery 2. GYN- Gynecology 3. LITHO- Lithotripter 4. MEDSPORT- Sports Medicine 5. NEURO- Neurosurgery 6. OPTH- Opthamology 7. ORAL- Oral Surgery 8. ORTHO- Orthopedics 9. OThER- Other Non-Specified Surgeries 10. OTO- Otolaryngology 11. PLASTICS- Plastic Surgery 12. SEC- Endocrine Critical Care 13. SGI- Gastroenterology 14. SON- Oncology 15. STX- Transplant 2

7 16. SVA- Vascular Surgery 17. TBE- Traumal Burn 18. THORACIC- Thoracic Surgery 19. UROLOGY- Urology Because some of the service data records were not dedicated to rooms, OPTH and OTHER were grouped into one room which was designated ROOMS for the simulation models. The types of surgeries used in our study are Inpatient, Admission Day Procedure (ADP), and Outpatient Surgeries. Note that the study uses the term Inpatient to refer to both Inpatient and ADP surgeries. The two procedures were considered the same in our data analysis. There are currently twenty-two operating rooms in the UMH. The number of rooms assigned to services varies by day. For example, cardiac is allocated three rooms on Monday and one room on Wednesday. C 3

The data was downloaded from the UMH SurgiServer database onto an IBM-DOS system.

8 APPROACH AND METHODOLOGY C I. Data Collection It was decided by Dr. Rutter that the data from the period of July December 1992 would be analyzed and used in the simulation model to determine operating room utilization by service and day of the week. The data was downloaded from the UMH SurgiServer database onto an IBM-DOS system. It was formatted into the DOS version of the Microsoft Excel spreadsheet program where it was parsed and prepared for data manipulation. The given data files contained the following information: Date of Surgery Day of Surgery Surgery Type Case Number Working Physician Start Time and Finish Time Total Surgery Time Surgery Type The master data file was divided into separate files for each service to help facilitate easier manipulation. Once the extracted file for each service was obtained, the data was sorted by surgery type (inpatient or outpatient). A distribution of surgery times for inpatient and outpatient cases for each service was constructed, using percentiles in increments of 10 ( i.e. 0,10,20 100). The arrival rates of cases were calculated for each day by the following equation: Total Number of Cases for each Day of Week ( 6 mo. period) (26 weeks)( 8 hours)( 60 minutes) The following guidelines and assumptions were used regarding service surgery times: Service surgery times were calculated for inpatient and outpatient cases separately. All surgery times from the data file were considered valid and used in distribution calculations. Data for weekend and emergent cases were not considered for this study, since they do not reflect the normal working schedule. The turnover time distributions were constructed in the same manner as service time distributions. The turnover times were calculated in a previous study, using SurgiServer 4

C data from December, 1991- March, 1992.

9 C data from December, March, The following assumptions were made regarding the service turnover times: Turnover times used were based on service, with no distinction between inpatient and outpatient cases If a computed turnover time was negative, it was considered a data entry error and excluded. Turnover times over 90 minutes were considered outliers, as determined by Dr. Rutter, and not used for analysis. Data used for the ACSC model was based on the surgeries removed from the UMH model. II. Simulation Simulation is the imitation of the operation of a real-world process or system over time. This imitation can be modeled through computer programs, which offer distinct advantages over other modeling techniques. Some of these advantages are: Simulation can combine retrospective data with hypothetical situations to produce realistic models. C; Once a model is built, it can be easily modified to reflect changes in procedure. By modifying various inputs, insight may be obtained into which variables are most significant and how variables interact. Simulation can be used to experiment with new designs or policies prior to implementation, in order to prepare for what may happen. The simulation language used for this project was GPSS/H version 2.0. It was run on a SUN SPARCstationl+ computer system. The model simulates the operating room scheduling practice for one year. The assumptions and guidelines incorporated into the model to best represent the true utilization of the operating rooms are giving in the User ManuaL The ACSC model incorporates the following guidelines and assumptions for the simulation model: 1) The model simulates scheduled surgeries from 7:30 AM - 5:30 PM, Monday through Friday. 5

2) The simulation was modeled using both four and six operating rooms to see how the number of rooms affected utilization. 3) The operating rooms are not dedicated to certain services. 4) At Dr.

10 2) The simulation was modeled using both four and six operating rooms to see how the number of rooms affected utilization. 3) The operating rooms are not dedicated to certain services. 4) At Dr. Rutter s request, cases were removed from the UIVIEI and placed in the ACSC under two different scenarios, which are as follows: Scenario 1: Remove the following services: I. ORTHO surgeries performed by Dr. Louis) II. ( Outpatient only) ifi. PLASTICS (Outpatient only) IV. OTO (Outpatient only) V. GYNECOLOGY ( Outpatient only) (Hand MEDSPORT Scenario 2: In addition to scenario 1, remove the following services: I. II. III. MEDSPORT (Inpatient) UROLOGY (in SON ( Outpatient only) LITHO) (Outpatient only) The UMHOR was modeled with both these scenarios removed and these models are referred to as Scenario 1 and Scenario 2 in the Results and Appendix sections. of III. Strengths and Limitations of the Simulation Model Strengths 1) The model allows for randomness and variability for the service and turnover times. With the high variance in service surgery times, using a mean time to sample from would not accurately reflect the operating room scheduling practice. However, using actual distributions from retrospective data more accurately reflects reality. 2) Resembles actual practice, since service case type, service times, and turnaround times are assigned based on proportions from retrospective data. 3) Can be easily modified to simulate different scheduling scenarios. Limitations 1) There was only one turnover time given for OPTH during the entire four month period. Because one data point would not be representative of the service s turnover time, a 6

standard time of 30 minutes, as defined by an earlier study on turnover times, was assigned to OPTH. This reduced the accuracy, or real-life aspect of the model.

11 standard time of 30 minutes, as defined by an earlier study on turnover times, was assigned to OPTH. This reduced the accuracy, or real-life aspect of the model. 2) In practice, same surgeon, same type cases are sequentially scheduled as much as possible to minimize turnover time. In the model, however, there is no consideration of equipment constraints, staff constraints, or case type. Therefore, a case is scheduled to any room that is dedicated to the cases particular service. C 7

Table 1. ACSC Utilization for Scenarios 1 and 2, with 4 and 6 rooms 8 C Table 1 shows the utilization times, by day, of the ACSC for Scenarios 1 and 2, with 4 and the increase is 46.3% with 6 rooms.

12 Table 1. ACSC Utilization for Scenarios 1 and 2, with 4 and 6 rooms 8 C Table 1 shows the utilization times, by day, of the ACSC for Scenarios 1 and 2, with 4 and the increase is 46.3% with 6 rooms. Within a given scenario, when rooms are increased from 4 to 6 rooms, the utilization times drop 28.7% and.06% for scenarios 1 and 2, ( respectively. 6 rooms. There is a 4.4% increase in utilization between scenarios with 4 rooms, while Average Utilization 95.81%I 1O %j 99.94% Utilization Utililization Utilization Utilihization Monday 99.00% % 99.99% Tuesday 91.87% % 99.92% Wednesday 95.99% % 99.98% Thursday 94.57% % 99.82% Scenario 1 Scenario 2 Scenario 1 Scenario 2 Friday 97.64% % 99.97% 4 rooms 6 rooms I.ACSC RESULTS

II. UMHOR Table 2. Average Service Utilization Times for Each Scenario (averaged from Monday - Friday) UMHOR Scenario 1 Scenario 2 CARDIAC 99.3 1% 99.42% 99.60% GYN 93.10% 65.22% 65.22% NEURO 95.

13 II. UMHOR Table 2. Average Service Utilization Times for Each Scenario (averaged from Monday - Friday) UMHOR Scenario 1 Scenario 2 CARDIAC % 99.42% 99.60% GYN 93.10% 65.22% 65.22% NEURO 95.79% 95.75% 95.66% ORAL 80.18% 82.21% 80.71% ORTHO 99.50% 94.40% 94.40% OTO 99.26% 79.83% 79.83% PLASTICS 97.35% 91.19% 90.44% SEC 99.71% 99.78% 99.77% SGI 93.95% 94.17% 93.70% SON 93.22% 93.17% 75.48% STX 86.30% 86.83% 88.42% SVA 98.40% 98.06% 78.84% TBE 40.99% 41.28% 40.97% THORACIC 84.96% 85.17% 84.32% UROLOGY 88.50% 88.75% 67.80% MEDSPORT 85.54% 57.53% LITHO 49.32% 49.22% 49.34% ROOMS 41.62% 41.24% 41.33% C ( Table 2 gives the average service utilization times over the course of one week (M-F). All utilization times where not considered for average calculations. The complete results for all of the simulation models is provided in the Appendix. 9

services under both scenarios does not bring the overall utilization of the UMHOR under I. From the results of the simulation models, it is clear that the removal of the outpatient 10 Manual.

For future project teams, we recommend simulating the ACSC with more operating necessary.

14 services under both scenarios does not bring the overall utilization of the UMHOR under I. From the results of the simulation models, it is clear that the removal of the outpatient 10 Manual. Note: Recommendations for the actual simulation models and code are given in the User rooms and a higher caseload if the UMH desires to move more outpatient surgeries. IV. For future project teams, we recommend simulating the ACSC with more operating necessary. utilization for scenario 2 with six rooms is extremely high, we recommend a six room ACSC with the possible addition of more outpatient cases from the UMET if the demand is ifi. The optimal scheduling system for the ACSC is scenario 2 with four rooms. Since the indicate a need to restructure their scheduling blocks to decrease idle time. II. The low utilization levels (45) for TBE, LITHO, and ROOMS services the desired level of 75.00%. Therefore, we recommend the removal of the services to the ACSC and possibly the removal of more outpatient services if the demand is high enough for the ACSC and the total utilization does not deviate too far from the desired level. RECOMMENDATIONS

15 XIGN3JJV ) )

16 C (

44% SEC 99.71% 99.78% 99.77% SGI 93.95% 94.17% 93.70% SON 93.22% 93.17% 75.48% STX 86.30% 86.83% 88.42% SVA 98.40% 98.06% 78.84% ThE 40.99% 41.

17 TJMHOR Combined Scenarios AVERAGE SERVICE UTILIZATION FOR EACH SCENARIO UMHOR SCENARIO 1 SCENARIO 2 CARDIAC 99.31% 99.42% 99.60% GYN 93.10% 65.22% 65.22% NETJRO 95.79% 95.75% 95.66% ORAL 80.18% 82.21% 80.71% ORTHO 99.50% 94.40% 94.40% OTO 99.26% 79.83% 79.83% PLASTICS 97.35% 91.19% 90.44% SEC 99.71% 99.78% 99.77% SGI 93.95% 94.17% 93.70% SON 93.22% 93.17% 75.48% STX 86.30% 86.83% 88.42% SVA 98.40% 98.06% 78.84% ThE 40.99% 41.28% 40.97% THORACIC 84.96% 85.17% 84.32% UROLOGY 88.50% 88.75% 67.80% MEDSPORT 85.54% 57.53% LITHO 49.32% 49.22% 49.34% ROOMS 41.62% 41.24% 41.33%

18 . I Jt C ::-.E. :1::i :..-:i sc :i...: ;. a..&. J.aaj.... a) - nv.t. rran.... -_. - tt;.t - - -:. aj it C I C:

UMH Operating Rooms NUMBER OF PERSONS PER DAY BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARD/DAY 4.44 4.21 3.12 4.03 3.96 GYN/DAY 6.85 6.79 5.90 4.85 5.85 NEURO/DAY 4.46 5.29 4.60 3.75 3.

19 UMH Operating Rooms NUMBER OF PERSONS PER DAY BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARD/DAY GYN/DAY NEURO/DAY ORAL/DAY ORTHO,DAY OTO/DAY PLAS/DAY SEC/DAY SGI/DAY SON/DAY STX/DAY SVA/DAY ThE/DAY THORiDAY TJROL/DAY MEDS/DAY LITHOiDAY ROOMS/DAY TOTAL SERVICED

SERVICE UTILIZATION BY DAY U1v111 Operating Rooms C. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 99.91% 99.71% 99.04% 98.48% 99.41% GYN 81.62% 99.85% 94.95% 93.22% 95.85% NEURO 96.57% 99.00% 95.

20 SERVICE UTILIZATION BY DAY U1v111 Operating Rooms C. MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 99.91% 99.71% 99.04% 98.48% 99.41% GYN 81.62% 99.85% 94.95% 93.22% 95.85% NEURO 96.57% 99.00% 95.71% 90.52% 97.15% ORAL 97.67% 62.68% ORTHO % 99.55% 99.36% 98.64% OTO 99.98% 99.91% 98.72% 99.94% 97.75% PLASTICS 88.99% 99.77% 99.90% 98.44% 99.64% SEC % SGI 93.86% 92.05% 99.73% 90.17% SON 96.14% 92.81% 90.71% STX 89.04% 83.18% 86.67% SVA 97.46% 98.18% 98.80% 99.16% TEE 31.86% 31.79% 33.33% 66.96% THORACIC 64.07% 92.58% 86.79% 96.38% UROLOGY 75.78% 98.50% 99.96% 99.98% 68.27% MEDSPORT 76.50% 93.63% 89.50% 82.53% LITHO 46.49% 49.09% 48.33% 49.94% 52.76% ROOMS 36.22% 47.01% C

UMH Operating Rooms AVERAGE WAIT TIME (MIN) IN WAITING ROOM BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 0.00 0.00 0.00 0.00 0.00 GYN 124.70 290.15 194.78 163.59 189.02 NEURO 197.

21 UMH Operating Rooms AVERAGE WAIT TIME (MIN) IN WAITING ROOM BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC GYN NEURO ORAL ORTHO OTO PLASTICS SEC SGI SON STX SVA TBE THORACIC UROLOGY MEDSPORT LITHO ROOMS

UM}{ Operating Rooms AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME AND TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRtDAY CARDIAC 274.73 287.25 291.06 291.56 275.

99 PLASCS 219.30 235.10 197.91 220.42 202.87 SEC 210.58 0.00 207.69 0.00 202.66 SGI 292.17 273.90 236.94 0.00 259.96 SON 0.00 206.22 0.00 218.52 180.54 STX 255.71 0.00 236.41 244.68 0.00 SVA 263.

22 UM}{ Operating Rooms AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME AND TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRtDAY CARDIAC GYN NEURO ORAL ORTHO OTO PLASCS SEC SGI SON STX SVA TEE THORACIC UROLOGY MEDSPORT LITHO ROOMS (

TJMHOR Scenario 1 NUMBER OF PERSONS PER DAY BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARD/DAY 4.25 4.25 3.04 4.17 4.04 GYN/DAY 2.38 3.85 1.94 3.83 1.92 NEURO/DAY 4.62 5.25 4.63 3.77 3.

23 TJMHOR Scenario 1 NUMBER OF PERSONS PER DAY BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARD/DAY GYN/DAY NEURO/DAY ORAL/DAY ORTHO/DAY OTO/DAY PLAS/DAY SEC/DAY SGIJDAY SON/DAY STXLDAY SVAiDAY TBE/DAY THOR/DAY UROL,DAY MEDS/DAY LITHO/DAY ROOMS/DAY TOTAL SERVICED

UMHOR Scenario 1 SERVICE UTILIZATION BY DAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 99.50 % 99.82 % 99.51 % 98.43 % 99.86 % GYN 46.66 % 87.53 % 50.50 % 86.45 % 54.95 % NEURO 97.08 % 98.

24 UMHOR Scenario 1 SERVICE UTILIZATION BY DAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC % % % % % GYN % % % % % NEURO % % % % % ORAL 0.00 % % 0.00 % % 0.00 % ORTHO % % % % % OTO % % % % % PLASTICS % % % 94.96% % SEC % 0.00 % % 0.00 % % SGI % % % 0.00 % % C.. SON 0.00 % % 0.00 % % % STX % 0.00 % % % 0.00 % SVA % % 0.00 % % % TBE % % % 0.00 % % THORACIC % % % 0.00 % % UROLOGY % % % % % MEDSPORT % % % % 0.00 % LITHO % % % % % ROOMS 0.00 % 0.00 % % % 0.00 % (

UMHOR Scenario 1 AVERAGE WAIT TIME (MJN) IN WAITING ROOM BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 0.00 0.00 0.00 0.00 0.00 GYN 0.00 117.62 0.00 110.05 0.00 NEURO 195.30 247.15 200.

25 UMHOR Scenario 1 AVERAGE WAIT TIME (MJN) IN WAITING ROOM BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC GYN NEURO ORAL ORTHO OTO PLASTICS SEC SGI SON STX SVA ThE THORACIC UROLOGY MEDSPORT LITHO ROOMS

UMHOR Scenario 1 AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME AND TURNAROUN]) TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 285.44 286.46 294.48 283.84 270.31 GYN 250.

26 UMHOR Scenario 1 AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME AND TURNAROUN]) TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC GYN NEURO ORAL ORTHO OTO PLASTICS SEC SGI SON STX SVA TBE THORACIC UROLOGY MEDSPORT LITHO ROOMS C.,

UMHOR Scenario 2 NUMBER OF PERSONS PER DAY BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARD/DAY 4.33 4.12 3.15 4.23 4.00 GYN/DAY 2.88 3.85 1.94 3.83 1.92 NEURO/DAY 4.62 5.17 4.62 3.79 3.

27 UMHOR Scenario 2 NUMBER OF PERSONS PER DAY BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARD/DAY GYN/DAY NEURO/DAY ORALIDAY ORTHO/DAY OTO/DAY PLAS/DAY SEC/DAY SGIJDAY SON/DAY STX/DAY SVAIDAY TBEiDAY THOR/DAY IJROL/DAY MEDS/DAY LITHO/DAY ROOMS/DAY TOTAL SERVICED

SERVICE UTILIZATION BY DAY UMHOR Scenario 2 CD MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 99.85 % 99.65 % 99.56 % 99.42 % 99.50 % GYN 46.66 % 87.53 % 50.50 % 86.45 % 54.95 % NEURO 96.25 % 99.

28 SERVICE UTILIZATION BY DAY UMHOR Scenario 2 CD MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC % % % % % GYN % % % % % NEURO % % % % % ORAL 0.00 % % 0.00 % % 0.00 % ORTHO % % % % % OTO % % % % % PLASTICS % % % % % SEC % 0.00 % % 0.00 % % SGI % % % 0.00 % % SON 0.00 % % 0.00 % % % STX % 0.00 % % % 0.00 % SVA % % 0.00 % % % TBE 31.27% % % 0.00 % % THOR.ACIC % % % 0.00 % % UROLOGY % % % % % MEDSPORT 0.00 % 0.00 % 0.00 % 0.00 % 0.00 % LITHO % % % % % ROOMS 0.00 % 0.00 % % % 0.00 % C

UMHOR Scenario 2 AVERAGE WAIT TIME (MIN) IN WAITING ROOM BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 0.00 0.00 0.00 0.00 0.00 GYN 0.00 117.62 0.00 110.05 0.00 NEURO 190.03 252.86 187.

29 UMHOR Scenario 2 AVERAGE WAIT TIME (MIN) IN WAITING ROOM BY SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC GYN NEURO ORAL ORTHO OTO PLASTICS SEC SGI SON STX SVA TBE THOR.ACIC UROLOGY M.EDSPORT LITHO ROOMS

TJM}jOR Scenario 2 AVERAGE TIME (MIN) IN OPERATING ROOM SERVICE INCLUDES SURGERY TIME AND TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC 280.50 295.80 289.58 283.28 272.53 GYN 250.

30 TJM}jOR Scenario 2 AVERAGE TIME (MIN) IN OPERATING ROOM SERVICE INCLUDES SURGERY TIME AND TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY CARDIAC GYN NEURO ORAL ORTHO OTO PLASTICS SEC SGI SON STX SVA TEE THORACIC UROLOGY MEDSPORT LITHO ROOMS C

20 131.77 ORTHOPEDICS 137.30 190.44 190.07 0.00 81.31 OTOLARYNGOLOGY138.52 146.94 144.18 143.

31 ACC Scenario 1 (4 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME AND TURNAROUND TIME MONDAY TUESDAY WEDNESDAYTHtJRSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICINE

00 0.00 0.04 SERVICING 1.40 0.10 0.56 0.46 1.17 (HOURS) PREPARATION 1.81 0.

32 ACC Scenario 1 (4 Rooms) RESULTS MONDAY TUESDAY WEDNESDAYTHtJRSDAY FRIDAY UTILIZATION % % % % % WAIT (HOURS) SERVICING (HOURS) PREPARATION (HOURS) AVG WAIT (MINUTES) C

00 0.00 0.00 0.00 SERVICING 0.10 0.00 0.12 0.00 0.02 (HOURS) PREPARATION 0.

33 ACC Scenario 1 (6 Rooms) RESULTS MONDAY TUESDAY WEDNESDAYTHVRSDAY FRIDAY UTILIZATION % % % % % WAIT (HOURS) SERVICING (HOURS) PREPARATION (HOURS) AVG WAIT S)

34 ACC Scenario 1 (4 Rooms) AVERAGE NUMBER OF PEOPLE SCHEDULED FOR EACH SERVICE C MONDAY TUESDAY WEDNESDAYTHURSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICrNE C

35 ACC Scenario 1 (6 Rooms) AVERAGE NUMBER OF PEOPLE SCHEDULED FOR EACH SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY7.0O PLASTIC SURGERY SPORTS MEDICiNE

ACC Scenario 1 (6 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME ANT) TURNAROUINI) TIME C,, MONDAY TUESDAY WEDNESDAY THURSDAY FRiDAY GYNECOLOGY 170.21 177.02 167.19 171.

36 ACC Scenario 1 (6 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME ANT) TURNAROUINI) TIME C,, MONDAY TUESDAY WEDNESDAY THURSDAY FRiDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICINE C.

ACC Scenario 2 (4 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME A1NE TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY 166.50 152.99 0.00 164.96 166.

37 ACC Scenario 2 (4 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME A1NE TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICINE (OUTPATIENT ONLY) SPORTS MEDICINE (INPATIENT ONLY) UROLOGY ONCOLOGY

ACC Scenario 2 (4 Rooms) RESULTS MONDAY TUESDAY

00 % 100.00 % 100.00 % 100.00 % WAIT 9.19 8.37 9.

79 2.06 (HOURS) PREPARATION 1.62 1.60 1.52 2.21 1.

38 ACC Scenario 2 (4 Rooms) RESULTS MONDAY TUESDAY WEDNESDAYTHURSDAY FRIDAY UTILIZATION % % % % % WAIT (HOURS) SERVICING (HOURS) PREPARATION (HOURS) AVG WAIT (MINUTES) C

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY RESULTS AVG WAIT 270.03 256.73 274.

75 (HOURS) SERVICiNG 3.08 2.63 3.44 3.19 3.17 (HOURS) WAIT 1.85 1.08 1.69 1.

39 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY RESULTS AVG WAIT (MINUTES) (HOURS) PREPARATION (HOURS) SERVICiNG (HOURS) WAIT UTILIZATION % % % % % ACC Scenario 2 (6 Rooms)

ACC Scenario 2 (4 Rooms) AVERAGE NUMBER OF PEOPLE SCHEDULED FOR EACH SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY 4.00 1.17 0.00 1.00 1.00 ORTHOPEDICS 1.88 0.00 0.00 0.00 0.00 OTOLARYNGOLOGY4.

40 ACC Scenario 2 (4 Rooms) AVERAGE NUMBER OF PEOPLE SCHEDULED FOR EACH SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICINE (OUTPATIENT ONLY) SPORTS MEDICINE (INPATIENT ONLY) UROLOGY (,) ONCOLOGY

ACC Scenario 2 (6 Rooms) AVERAGE NUMBER OF PEOPLE SCHEDULED FOR EACH SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY 4.69 3.85 0.00 1.00 3.54 ORTHOPEDICS 2.00 0.69 0.00 0.00 0.00 OTOLARYNGOLOGY6.

41 ACC Scenario 2 (6 Rooms) AVERAGE NUMBER OF PEOPLE SCHEDULED FOR EACH SERVICE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICINE (OUTPATIENT ONLY) SPORTS MEDICINE (INPATIENT ONLY) UROLOGY ONCOLOGY

ACC Scenario 2 (6 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY

WEDNESDAY THURSDAY FRIDAY GYNECOLOGY 150.40 137.76 0.00 164.96 105.

34 149.01 135.53 114.73 PLASTIC SURGERY 137.06 0.00 181.74 136.02 203.

72 (OUTPATIENT ONLY) SPORTS MEDICINE 168.20 179.55 185.95 223.15 204.

42 ACC Scenario 2 (6 Rooms) AVERAGE TIME (MIN) IN OPERATING ROOM BY SERVICE INCLUDES SURGERY TIME AND TURNAROUND TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY GYNECOLOGY ORTHOPEDICS OTOLARYNGOLOGY PLASTIC SURGERY SPORTS MEDICINE (OUTPATIENT ONLY) SPORTS MEDICINE (INPATIENT ONLY) UROLOGY ONCOLOGY C

53% 94.95% _CD Monday :: 81.62% I 10.00 20.

43 GYNECOLOGY SERVICE UT1 LIZATION UMHOR E Scenario 1 Scenario 2 Friday 54.95% Thursday 86.45% IU) Wednesday Tuesday % % 87.53% 94.95% _CD Monday :: 81.62% I / 0/ I / 0/ 0/ 0/ 0/ 0/ Utilization

44 Utilization Monday % % 97.50% 98.50% 99.00% % 99.50% I I + + Wednesday 99,51% 99.50% Tuesday Thursday 98.43% Friday 99.86% UMHOR Scenario 1 Scenario 2 CARDIAC SERVICE UTILIZATION ci) ci) j 99.82%

45 ORAL SURGERY SERVICE UTI LIZATION UMHOR Li Scenario 1 Scenario 2 Friday Thursday aa.aa% 2.68% ci Wednesday Tuesday 98.14% 97.75% 97.a7% Monday I 000% I / Utilization / 10 0F

46 NEUROSURGERY SERVICE UTI LIZATION riumhor Scenario 1 Scenario 2 Friday % 97.15% Thursday 88.90% % 90.52% I Wednesday 95.62% p6.49% Tuesday j98.92% 99.00% Monday [25% % 96.57% I I I I I I i I I I 82.00% 84.00% 86.00% 88.00% % 94.00% 96.00% 98.00% / Utilization

47 OTOLARYNGOLOGY SERVICE UTI LIZATION S UMHOR i Scenario 1 5 Scenario 2 Friday % 72.66% % Thursday 91.32%.94% ci) 0 >% Wednesday % 70.82% % Tuesday 83.70% Monday I 80.65% I -I - I - -I % / 0 o io / % 0! 0 Utilization / 0/ 0 0f

48 ( ORTHOPEDIC SERVICE UTI LIZATION S UMHOR LI Scenario 1 Scenario 2 Friday T 82.74% 82.74% 98.64% Thursday Wednesday j94.49%.3.80% 98.80% C Tuesday % Monday I I I I I I I a f 0/ 0/ 0/ 0/ 0/ Utilization / 0/ 98.57% 98.57% I f

13% Thursday a) a) > C Wednesday 10 10 10 Tuesday Monday I I I I

49 - SEC SERVICE UTILIZATION UMHOR Scenario 1 Scenario 2 Friday 99.30% 99.33% 99.13% Thursday a) a) > C Wednesday Tuesday Monday I I I I I I I ! 0! 0! 0! 0! 0! 0! 0! 0! 0! Utilization

50 PLASTIC SURGERY SERVICE UTI LIZATION UMHOR LI Scenario 1 Scenario 2 Friday 93J3% % 99.64% 96.71% Thursday > Wednesday 93.65% 94.43% 99.90% Tuesday % 99.31% 99.77% L( 7( U 7.1 U Monday 73.76% I I I I I I ! 0! 01 0! Utilization ! C.

51 SON SERVICE UTILIZATION UMHOR LI Scenario 1 Scenario 2 Friday 90.61% 90.71% Thursday % 92.17% a) Wednesday Tuesday 96.73% Monday I I I I I I I I I I ! 0/ Utilization / 01

52 SGI SERVICE UTILIZATION S UMHOR Scenario 1 5 Scenario % Friday 93.49% 90.17% Thursday Wednesday Tuesday % 99.73% I % Monday % % / 0/ 0/ 0! f Utilization / 0 0/ / 0/

53 SVA SERVICE UTILIZATION Friday T [ UMHOR E Scenario 1 Scenario % 99.25% 99.16% Thursday 97.87%. a) Wednesday 99.27% Tuesday 98.00% 98.18% 98.13% Monday 97.12% I I I I I I I F F I I Utilization f 01

54 STX SERVICE UTILIZATION C S UMHOR E Scenario 1 Scenario 2 Friday Thursday 83.29%. a) > Wednesday + E % 88.22% ole C Tuesday Monday ]88.99% I I I Utilization 89.04% C

55 THORACIC SERVICE UTILIZATION UMHOR E Scenario 1 Scenario 2 Friday % 94.96% Thursday a) > Wednesday 88.09% 85.01% I579% Tuesday % 93.43% Monday Li 67.26% % I / 0 I ! 0! Utilization of

56 TBE SERVICE UTILIZATION UMHOR El Scenario 1 Scenario 2 Friday 68.49% a.9a% 1) >% Cl Thursday Wednesday 1.99% 32.34% c Tuesday h2.23% 33.92% F.79% Monday 30.37% 31.86% I I % Utilization C.

MEDSPORT SERVICE UTILIZATION UMHOR El Scenario 1 Scenario 2 Friday Thursday 54.66% 82.53% 0 I Wednesday 160.63% 189.

57 MEDSPORT SERVICE UTILIZATION UMHOR El Scenario 1 Scenario 2 Friday Thursday 54.66% 82.53% 0 I Wednesday % % Tuesday 57.19% Monday 57.64% I 0/ 0/ / 0/ Utilization % % % % %

58 n UROLOGY SERVICE UTILIZATION UMHOR LI Scenario 1 Scenario 2 Friday % % % Thursday 99.98% C) C) >% Wednesday + [ % J99.97% Tuesday / 98.23% 19850% Monday % J 77.72% 75.78% Utilization /

59 ROOMS SERVICE UTILIZATION UMHOR E Scenario 1 E Scenario 2 Friday a) I Thursday Wed nesday Tuesday H 3622% 38.82% [42.93% 43.a5% Monday I I I 5.00% ! 0! ! 0/ 0 Utilization /

60 I ( LITHOTRIPTER SERVICE UTI LIZATION S UMHOR E Scenario 1 5 Scenario 2 Friday 52.93% I_276% 53.37% 48.07% 1) Thursday 47.51% 49.94% C I Wednesday 47.37% Tuesday 48.a2% % Monday 49.21% 50.11% -I % 44.00% 46.00% 48.00% % 54.00% Utilization

61 ACC UTILIZATION (6 Rooms) Scenario 1 LI Scenario 2 10!_ 99.98% 99.82% 99.97% % 73.82! a7.72 aa ! N C I I - -H + >. a o a -o4,, >- >- > U) G) D C - 0 I ci) Day of Week

62 ( ACC UTILIZATION (Scenario 1) 4.Rooms El 6 Rooms % 95.99% 94.57% 97.64% C 0 -I CN % 1.9á% a.17% 1.88% >. >. C C 0 C0 U, ci) -H > C 0 U, ci) C ci) 1 >- C C 0 U, U I Day of Week (

Genesis Hospital. Surgery Simulation. Curtis Theel, MBA, CSSBB, PMP 2016 ASQ Columbus Spring Conference March 7 th, 2016

Genesis Hospital. Surgery Simulation. Curtis Theel, MBA, CSSBB, PMP 2016 ASQ Columbus Spring Conference March 7 th, 2016 Genesis Hospital Surgery Simulation Curtis Theel, MBA, CSSBB, PMP 2016 ASQ Columbus Spring Conference March 7 th, 2016 Background information In 2011, Genesis Healthcare System decided to combine 2 separate