Using Fileman to Obtain More Accurate Times for Surgeries by Surgeon

1. Using Fileman to Obtain More Accurate Times for Surgeries by Surgeon Kevin McGuire, RN, BSN, CAC Karen Putnam, RN, MPH, OR Manager

2. Background • Karen Putnam, RN, BSN, MPA Eighteen years experience in the Operating Room Nine years as OR Manager • Kevin McGuire, RN, BSN, CAC Eighteen years experience Operating Room Two months CAC Began April 2003 with the VA Mather OR

3. Some History • 2003 - Many Reports were still being manually generated by using paper printouts.

4. More History • Led me to inquire about database tools I knew must be available. • Search led me to Fileman and Stephen G. Hill who got me access and good start. • Once we got a glimpse of the power of Fileman, all those remotely involved with Scheduling agreed some sort of Report Averaging the Room Times required for a Surgery by a given Surgeon was a worthy project.

5. Goal of the Operating Room Schedule To efficiently use the time allotted for scheduled surgeries by NOT: Under-Utilizing -or- Over-Utilizing OR time Available.

6. Under-utilization • Refers to an Operating Room that remains empty though it is cleaned, equipmentally functional and is sufficiently staffed. 1) Leads to excessive backlog of Veterans needing elective surgeries. 2) Increased potential for Idle Paid Staff.

7. Over-Utilization • One or more Procedures going over their scheduled time. • Leads to delays for cases to follow. • Opens the possibility for cancellation of a scheduled elective surgery. (i.e. Patient does not want to wait, After hour staffing issues – how many Call Teams)

8. Reasons for Surgeries going Overtime • The unexpected – cannot plan for.

9. Reasons for Surgeries going Overtime Whadda Ya mean We only have time for an Appendectomy?

10. More Reasons for Overtime Surgeries • “Bump” by Urgent/Emergent case

11. List of Delay Causes in Fileman Surgery File # 130, Field # 42 (Qty 26) • Choose from: • ANESTHESIA PROCEDURE DELAY • ANESTHETIST NOT PRESENT • BED AVAILABILITY • BLOOD LATE • Bed Availability • CONTAMINATION OF FIELD • HEMOTOLOGY REPORT LATE • ICU BED NOT AVAILABLE • IMED CONSENT • INCOMPLETE CHART • INSTRUMENT NURSE NOT PRESENT • INSTRUMENTS NOT READY • OPERATING SURGEON NOT PRESENT

12. More Delay causes - Fileman • OTHER • PATIENT ACTION • PERMIT NOT READY • PRE-OP CARE NOT COMPLETED • PREVIOUS CASE DELAYED • SPECIAL EQUIPMENT NOT READY • STAFF SURGEON NOT PRESENT • SURGICAL NURSE NOT PRESENT • SURGICAL PROCEDURE DELAY • TRANSPORTATION DELAY • WARD DELAY • X-RAY PERSONNEL UNAVAILABLE • X-RAY REPORT LATE

13. More Reasons for Overtime Surgeries The unappreciated Can plan for but frequently gets missed. • Difficult IV start • Difficult Intubation • Atypical positioning/setup

14. More Reasons for Overtime Surgeries • Inaccurate time needed for Surgery provided by Surgical Service …Focus of this Presentation

15. Surgery Times Provide by Surgical Service • Subjective Data - Influenced by a Genuine Desireto help as many of their patients as possible. (i.e. “Let’s squeeze them in here, between the mega and the super mega.”) • Objective Data Needed - Inanimate history based tool needed to remove “emotional” factor.

16. Fileman to the Rescue • A sort order of data by: 1) Surgeon 2) CPT Code 3) Date of Surgery - Grouped Surgeries by Surgeon first - Within each Surgeons’ Grouping, the surgeries were grouped by CPT Code. - The Date parameter limited the data to a specific date range.

17. Surgery File #130 and Fields

18. Fileman Sort • OUTPUT FROM WHAT FILE: SURGERY// • SORT BY: NUMBER// .14 SURGEON • START WITH SURGEON: FIRST// A • GO TO SURGEON: LAST// Z • WITHIN SURGEON, SORT BY: 27 PLANNED PRIN PROCEDURE CODE • START WITH PLANNED PRIN PROCEDURE CODE : FIRST// • WITHIN PLANNED PRIN PROCEDURE CODE , SORT BY: .205 TIME PAT IN OR • START WITH TIME PAT IN OR: FIRST// 110103 (NOV 01, 2003) • GO TO TIME PAT IN OR: LAST// 103105 (OCT 31, 2005)

19. Fileman Export Fields • FIRST EXPORT FIELD: SURGEON// • THEN EXPORT FIELD: PLANNED PRIN PROCEDURE CODE // • THEN EXPORT FIELD: PRINCIPAL PROCEDURE// • THEN EXPORT FIELD: MINUTES(#11,#10)// • THEN EXPORT FIELD: PATIENT IN OR TIME// • THEN EXPORT FIELD: OPERATION TIME// PATIENT IN OR TIME is the field used in the final Report to determine the amount of time to schedule the Surgery. It is the actual Time in Room in Minutes.

20. Excel Screen shot

21. Final Report

22. Before and After Minutes 492885 517670 463835 413355 12.1% 5.03%

23. Percent Scheduled Time Exceeded

24. Other Fields to Evaluate Effectiveness • Field # 18 in the Surgery File (Qty 56) • Cancel Reason • Choose from: • ADMINISTRATIVE CANCELLATION • ALREADY DONE • ANESTHESIA • BLOOD NOT AVAILABLE • CHANGE IN ORDER OF CASES • CONSULT NOT DONE • DEATH • DOCTOR ILL • DOCTOR'S ORDERS • DOCTOR'S SCHEDULE • DUPLICATION • EMERGENCY CASE SUPERSEDES • EQUIPMENT PROBLEM

25. Cancel Reasons Continued… • ICU BED • INCONVENIENT DATE FOR PT • INTRAOP CHANGE/MEDICAL STATUS • LAB TEST • MEDICAL • MISSED SHUTTLE • MRI,XRAY OR CT NOT DONE • NO CONSENT • NO LONGER NEEDED • NO ONE WITH PATIENT • NO PRE OP DONE • NO TRANSPORTATION • NURSING TEAM • OPERATING ROOM

26. Cancel Reasons Continued… • PATIENT CHANGES MIND • PATIENT ILL • PATIENT LATE • PATIENT MOVED • PATIENT NO-SHOW • PATIENT NOT NPO • PATIENT WOULDN'T GIVE REASON • PATIENT'S BEHAVIOR • PATIENT'S JOB • PATIENT/GUARDIAN REFUSES • PERSONAL EMERGENCY-PATIENT • PERSONAL PROBLEMS -PATIENT • PHYSICIAN NOT CREDENTIALLED • PRE-OP NOT DONE

27. And More Cancel Reasons • PREV. CASE LENGTH • PT CONFUSED • PT DIDN'T FOLLOW INSTRUCTIONS • PT DIDN'T SAY • PT PASSED AWAY • PT PREFERS ANOTHER TIME • PT STATES UNAWARE • RESCHEDULED TO LATER DATE • SCHEDULING ERROR • SURGEON • TRANSFERRED CARE TO ANOTHER VA • UNABLE TO REACH PATIENT • UNKNOWN • WEATHER CONDITIONS • X-RAY

28. Final Note & Resources • Final Note: Be aware that there are people “Out there” that have Inside knowledge of how their department functions, who also have computer application skills that make them useful resources. • Resources: Fileman - http://www.va.gov/vdl/application.asp?appid=5 http://www.hardhats.org/fileman/FMmain.html

29. Questions ???