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November 1996 Benchmarking the perioperative process.David Watkins, M.D., PH.D.; Accepted for Publication, Journal of Clinical Anesthesia [ see abstract below ] Systematic management of the perioperative process involves far more than simple staff reductions, decreases in"OR turnover times" and "decreasing PACU times". To date, little has been done to introduce a consistent, objective process with which to describe the various steps throughout the perioperative process and even less known about the benchmark performace criteria which are associated with these steps. This article begins a systematic approach to introducing this process into perioperative period. Return to the Current Literature Review Front Page, or read the abstract: ABSTRACT The article presents an overview of the design and application of a real-time patient routing system, based on bar-code and local area network technology, that was designed to track the progress of patients during the perioperative process. We present data on all patients undergoing ambulatory surgery. Patients' progress during their surgical stay was recorded at 17 strategic events using this real-time patient tracking technology. These times were used to identify inefficiencies in the perioperative process, by identifying bottlenecks and areas of high variation. We found that both raw and actual OR utilization efficiency was less than 50%. Points of high variation in a patient's progress occurred during: the time from admit to the hospital until the patient was ready for the OR; the time from when a patient was ready for the OR until they were called for, and; the time a patient spends in the OR pre-operative holding room. Causes for variation were identified and traced back to individual procedures, activities, and work processes. Multidisciplinary improvement teams were created to improve the pinpointed problem areas. The real-time patient routing system is a process which has proven to be highly valuable to all participants in the surgical process in bringing about rational, data driven efficiencies in perioperative services. This process has the potential to facilitate multidisciplinary cooperation in efforts to contain and reduce costs of perioperative services. Address reprint requests to Professor Watkins, at the Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh School of Medicine, Montefiore University Hospital, 200 Lothrop Street, Pittsburgh, PA 15213-2582 |
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