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Smooth Operations
A bigger push to start surgeries on time is showing signs of success.

There’s an honor roll of sorts stuck to the walls of Hopkins Hospital’s operating rooms. In big print, posters list the names of surgeons and anesthesiologists who, on at least 80 percent of occasions, started the day’s first cases on time during the previous month.

As the list has grown—the result of an effort this year to start surgeries punctually—the names of those who don’t hit the mark are becoming more noticeable by their absence. “Everyone knows who’s not on the list,” says Bob Scheu, the hospital’s first senior director of perioperative services.

Late-starting cases have been a problem in the ORs for years. And if it happens with the morning’s first procedure, it produces a ripple effect throughout the day that can lead to overworked surgical teams and patient dissatisfaction.

The idea of publicly identifying those who start on time has helped bring about a surprising success. A year ago, just 43 percent of cases started on time, but a few months after the posters went up, that figure had jumped to nearly 75 percent. The goal is 80 percent or higher.

It’s just one example of what hospital leaders had in mind when they brought in Scheu in August 2006 to improve coordination and work flow in the operating rooms. Many of Scheu’s duties, which cover the General, Weinberg and Outpatient Center ORs, as well as preoperative care and recovery areas, were previously handled piecemeal by different departments. He’s familiar with the role, having worked for five years as Pennsylvania Hospital’s vice president for perioperative services.

Because Scheu’s clout extends across multiple areas, he can help get things done where others haven’t before. After he arrived, he helped organize a committee that includes seven surgical department chairs, as well as Richard “Chip” Davis, Hopkins Medicine vice president for innovation and patient safety, to oversee OR management and improve cooperation between their departments and support services. In the past, it was hard for these bailiwicks to influence one another.

While on-time case starts have increased, Scheu and department leaders are currently looking at a more vexing problem—the roughly 200 cases a month that are cancelled on the day of surgery. That represents 8 percent of all cases, a number that is out of line with other hospitals, which tend to cancel 3 percent to 5 percent.

Unfortunately, there aren’t two or three main causes of cancellations that the group can target. The reasons vary widely. Preoperative surgical workups weren’t done. Insurance paperwork wasn’t finished in time for pre-certification. Patients eat when they’re not supposed to. The list goes on.

The improvement strategy, Scheu says, is to share cancellation data with the surgeons and their offices, set performance expectations and work together to meet goals. “Fortunately,” he says, “we have a lot of people pulling together to improve the service we provide to patients.”


—Jamie Manfuso



Johns Hopkins Medicine

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