Literature Review.                                                                                                                                                        Objective:  To prepare a review of the literature pertinent to a selected problem for healthcare research and to use that review to propose a methodology to address the problem.
Journal of Investigative Surgery, 29, 316–321, 2016
C 2016 Taylor & Francis Group, LLC
Copyright
ISSN: 0894-1939 print / 1521-0553 online
DOI: 10.3109/08941939.2016.1149638
NEW METHODOLOGY
Integrated Practice Improvement Solutions—Practical
Steps to Operating Room Management
Mikhail Chernov, MD, PhD, Janet Pullockaran, MD, Angela Vick, MD, Galina Leyvi, MD, MS,
Ellise Delphin, MD, MPH
Montefiore Medical Center, Weiler Hospital, New York, New York, USA
ABSTRACT
Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a
major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement
Methodologies (PIMs), “Integrated Practice Improvement Solutions” (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR
efficiency and productivity by better utilization of existing resources. Materials and Methods: OR efficiency was
measured both before and after IPIS implementation using the total number of cases versus room utilization,
OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time
start and the turnover time (TOT) were measured in parallel. Results: IPIS implementation resulted in increased
numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases
of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%).
The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. Conclusion: IPIS, an effective and flexible practice improvement model, was designed to
quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of
its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital
administration.
Keywords: OR management; methodology; OR efficiency; quality improvement; patients care; safety
INTRODUCTION
Improvement Methodologies (PIMs) (Table 1) to both
healthcare management in general and to OR management in particular. In recent publications, those most
often used were LEAN, Six-sigma and Critical Pass
Methodologies [7–9]. Broadly based on the P-D-C-A cycle, publicized in works of William E. Deming [10] in
1950s most of these methodologies have similar core
principles but vary in practices and methods of implementation [11]. Each has unique elements that are
specifically applicable for improvement in different areas of OR management. However, these tools were not
specifically designed for this purpose and their application to the task has often been random at best and
with inconsistent results [12]. In addition, utilization of
a single non-specific approach may significantly limit
flexibility in management choices and affect outcomes.
Therefore the authors developed and implemented a
step-to-step method for OR management, utilizing elements of existing PIMs applicable to specific key practice areas (KPA) of perioperative management.
More than 20 years of cost-cutting measures in healthcare have caused a significant shift in the revenueto-expense ratio primarily due to rapidly rising expenses [1–3] and corresponding shifts in our approach
to medicine from “science and art” to a “business.”
Medicine arrived to the business world with a significantly different concept and approach focusing on
patient care rather than material management, efficiency, and profit [4, 5]. This approach created multiple challenges due to lack of an industry accepted
business plan or model, quality control criteria, metrics, and formally trained managers [2]. As a result,
healthcare management is, in most cases, nonscientific and based primarily on “best knowledge.” One
area in which this is most evident is the perioperative
environment. To improve efficiency of the operating
suite—the main source of elective admissions and revenue [6], attempts have been made to apply Practice
Received 20 July 2015; accepted 14 December 2015.
Address correspondence to Mikhail Chernov, MD, PhD, Montefiore Medical Center, Weiler Hospital, 1825 Eastchester Avenue, New York, NY