CalculatOR^™

Overview

With revenue falling, most health care systems have implemented cost reduction programs in an attempt to balance their budgets. Because staff salaries represent the largest component of operating room costs, facilities that wish to minimize expenses need to focus particular attention on manpower costs. To accomplish this objective while maintaining a high level of service to patients and surgeons, cases must be scheduled in such a way as to optimize human resource use to get the cases done with a minimum of excessive staff and overtime.  This optimization requires computationally intensive mathematical methodologies that go well beyond traditional measurement of OR utilization.

Over the past several years, definitive staffing algorithms have been developed and published in the medical literature by Franklin Dexter, MD, PhD and his colleagues.  These algorithms have been incorporated into CalculatOR^™ to allow the practical application of these new methodologies.

CalculatOR^™ takes data collected by virtually any operating room or anesthesia information system and analyzes it to minimize staffing costs. Based on the start and end times of cases, the service performing the case, and the case type (urgent or elective), the program makes recommendations for the following areas of operation:

First Shift Staffing and Surgical Service Block Allocations
The number of first start of the day rooms that should be allocated to specific surgical services on each weekday is calculated so as to minimize staffing costs to the hospital. This analysis is based on the higher cost of over-utilized hours (elective surgical cases that continue after the completion of regular hours) compared to the cost of regular hours. The program determines for each surgical service whether it is less expensive to assign it one or more block allocations, or less expensive to combine that service with other services who schedule into "open block" rooms. Thus, surgical services receiving block allocations will get guaranteed first start times, whereas the combined services will not have such a guarantee.  CalculatOR^™ handles situations where for administrative or patient safety reasons a block assignment must be made, and can automatically provide room allocations where there is a need to open a specified number of rooms each day.

Second Shift Staffing
Cases that run beyond regularly scheduled hours can be managed either by personnel working late (after the end of regularly scheduled hours), or by a second shift of individuals. Both arrangements are expensive. CalculatOR^™ does a sophisticated analysis to determine if the facility would be better off financially providing such coverage using overtime. The cost associated with providing various numbers of second shift staff are determined, and the program recommends the staffing levels that minimize this cost.

PACU Staffing
Many operating rooms experience frequent delays in admitting patients to the PACU due to a lack of  sufficient staff to meet recovery room staffing standards. PACU managers attempt to balance the workload with staggered staffing assignments, but these efforts are suboptimal.

CalculatOR^™ analyzes the patterns of PACU admissions and calculates millions of possible shift combinations. Combinations with the minimum number of total staff hours that provide for a specified percentage of days where no PACU delays occur are reported.

Weekend Staffing
Staffing for weekend surgery (planned and unplanned) requires teams of staff to be either on site or quickly available. If too many staff are on call, hospital costs rise, whereas if too few staff are assigned, then patient care may suffer. CalculatOR^™ analyzes weekend cases and determines among the many millions of possible shift combinations, the combinations that minimize the amount of call hours while providing a designated level of availability to do all the cases.

Turnover Time Analysis
Excessive turnover time between surgical cases is a frequent topic of discussion at surgical OR committees. CalculatOR^™ performs a quantitative analysis of the potential financial savings to a facility that could accrue from reducing turnover time from current levels. The analysis is based on optimal 1st shift staffing.

Cost and Productivity Analysis
At many facilities, surgeons are allowed to schedule cases in a manner that can be very inefficient from the perspective of OR staffing. Inappropriate surgical allocations, gaps in the OR schedule, and other problems lead to excessive costs that are not offset by third party reimbursement. CalculatOR^™ performs a quantitative analysis of the expected financial impact to hospitals of implementing changes to OR allocation and case scheduling. It also provides a basis from which anesthesia department chairman can negotiate hospital subsidies when the hospital chooses not to maximize OR efficiency.

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