Strategies for Performance Improvements in Operating Rooms and Emergency Rooms

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Most of operating rooms (OR) in hospitals have limited capacity and incur huge costs. Improving the turnaround time is one of the most effective strategies that can be adopted to enhance OR capacity and reduce associated costs (Meyer et al., 2004, p.3). Another problem that hospitals grapple with is the waiting time in the emergency rooms (ER). Many patients spend considerable time in the ER waiting to be served. This paper will thus address strategies and tools that hospitals can use to identify prospects for performance improvements in OR as well as ER.

Data Required to Monitor Improvement in TAT in OR

One of the challenges that hospitals encounter is how to identify the data needed to monitor improvements especially in operating rooms (OR) and emergency rooms (OR). It goes without saying that many healthcare organizations have plenty of data. However, this data is scarcely translated into meaningful information for the benefit of the patients (Graham, 2008, p.10). There are several types of data that can be used to monitor improvement in the turnaround time in OR as well as reduce the waiting time in ER. For example, clinical data can be used to monitor performances in OR and ER. Clinical data consists of information about the health condition of patients, patients outcomes and data on screening processes. In addition, clinical data is used to measure a number of medical interventions including medication treatment, surgical processes, blood usage and infection control processes (Graham, 2008, p.10). Patient satisfaction data is another example. The hospital can use patients satisfaction data to identify prospects for performance improvement in OR and ER. Patient satisfaction data can be used to determine whether the patients were satisfied with the services they got from OR and ER. This type of data is also used to determine whether the environment at OR and ER was conducive and comfortable for recovery. Another critical data is the patient/family grievances. Data on grievances can provide critical information in terms of the potential problems within the OR and ER processes (Graham, 2008, p.11).

Employee satisfaction data can also be used to monitor improvements in TAT in the OR and reduce waiting time in the ER. Some of the salient features of the employee satisfaction data are: employee turnover data; absenteeism data; workplace accidents data; career prospects data; work load data; perception of safety data; dispute resolution data; as well as data on employee perception of management. Some of the data needed to monitor turnaround time in OR include data on timeliness of patient preparation; data on surgeon start-time; data on apparatus reliability; data on OR preparedness; and data on appropriate auxiliary medical staff (Graham, 2008, p.11).

Tools Used To Collect Performance Information

Patient Satisfaction Survey

Patient satisfaction survey is an important tool used to collect performance information in OR and ER. Survey can be used to collect information about patient opinion of care after healthcare services have been dispensed. There are various ways to obtain survey data. These include personal interviews, internet, e-mail, focus group discussions, and telephone interviews. The hospital can also mail survey instruments (such as questionnaires) to patients homes. The hospital can also administer surveys themselves or employ the services of an organization that specializes in data collection. In addition, the hospital can get survey replies directly from the patients after care has been dispensed (Graham, 2008, p.23). Survey instruments are used to collect information such as: responsiveness of medical staff, pain management, quietness and cleanliness of the hospital environment; time taken to get medical attention, discharge information and communication about treatment (Graham, 2008, p.25).

Telephone Interviews

Telephone interviews are also effective tools that used to collect performance information. Telephone interviews comprise of both open-ended and closed-ended questions that are used to collect data on patient satisfaction after healthcare services have been dispensed. Data collected through telephone interviews include the patients demographic attributes, time taken to arrive at the healthcare facility, patients experiences in terms of getting medical attention at the healthcare facility (particularly turnaround time at the OR as well as the waiting time in the ER). Telephone interviews are also used to assess whether patients were satisfied with the manner in which they were treated by the medical staff at the OR and ER. Telephone interviews is an effective tool to collect data because it gives opportunity to patients to express in their own words whether they were satisfied with the various medical services they received at the OR and ER. It also enables them to make suggestions on changes that should be adopted to improve service delivery at the OR and ER (Muhondwa et al., 2008, p.68).

Medical Chart Review

Medical chart review is also an extremely important tool used to collect performance information in OR and ER. This document is used to collect data on patients satisfaction as well as medical malpractices claims. Medical chart review contains important information such as medical reviews, medical therapies, medical litigations as well as medical misconducts by physicians, nurses and other employees at the hospital. The medical chart review document also contains summaries of personal medical records for each patient at the hospital, the medical procedures used to treat patients and the outcomes. Patients can also request a copy of their medical chart review to assess the type of medical treatment they receive. Medical chart review also contains information about the medical procedures that are relevant to patients specific status. The medical chart review enables the hospital to identify those areas that require urgent corrective measures to improve performance (Watson, 2003, p.13).

Tools Used To Measure and Display Quality Improvement Data

Control Charts

A control chart refers to a sequential time series plot that measures critical variables. The data plotted on a control chart can in form of rates, percentages, averages or even proportions (Woodall, Adams &Benneyan, 2011, p.2). A typical control chart has control limits (lower and upper thresholds) which are computed and plotted using process data. These limits describe the accepted range of deviation within which the plotted data must oscillate. Any data that fall outside the control limits may signal either quality deterioration or quality improvement (subject to the type of control limit crossed). Control charts are increasingly being used by hospitals measure and display quality improvement data. Some of the critical data measured by control charts include turnaround time in the OR, waiting time in the ER, patients satisfaction scores, post operative lengths of stay, emergency service response times, medication errors and infection rates. Control charts can be used by hospitals to study and monitor these variables (particularly the TAT in OR as well as waiting time in the ER) so as to make notable improvements in the quality of medical services dispensed. Control charts are thus valuable tools for monitoring quality improvement as well as assessing and validating improvement ideas (Woodall, Adams &Benneyan, p.2).

Comparison Charts

A comparison chart is a graphical diagram made up of observed (or actual) ranges, projected ranges and expected rates (lower and upper limits) for a specific period of time. The anticipated range is used to define the level of confidence that a given point differs from the average score. Comparison charts are mainly used healthcare institutions (especially in the OR and ER) to tell whether the chosen performance measure demonstrates one of the three forms of measurement results: excellent performance; average performance; or poor performance. The hospital is thus able to use data generated by comparison charts to identify areas (such as TAT in OR as well as waiting time in ER) that need improvement. For example, the comparison chart makes a comparison between the turnaround times in the operating room with its risk adjusted data or its comparison group. In essence, the comparison chart provides a useful guide to the hospital concerning whether it should carry on monitoring the performance improvement process (such as TAT in OR as waiting times in ER) in order to sustain the present level of performance or whether there is a justifiable reason to improve the present performance. Comparison charts can also be used within the hospital settings. For example, they can be used to monitor the TAT in OR for different periods. On the same note, comparison charts can also be used to monitor the waiting times in the emergency room. The data generated by comparison charts for different periods are compared to identify opportunities for performance improvements (Lee & McGreevy, 2002, p.129).

Conclusion

Both the OR and ER are crucial departments in any hospital. Nonetheless, they experience several problems that affect the manner in which healthcare services are dispensed. This paper has discussed various tools (such as survey methods, telephone interviews, control charts, etc) that can be used to improve the turnaround time in the OR as well as reduce the waiting time in the ER.

References

Graham, J. (2008). Managing Performance Measurement Data in Health Care. Washington D.C: Joint commission Resource.

Lee, K.Y., & McGreevy, C. (2002). Using Comparison Charts to assess Performance Measurement Data. Journal on Quality Improvement, 28, 129-138.

Meyer et al. (2004). Hospital Quality: Ingredients for Success: Overview and Lessons Learned. Washington, D.C: The Commonwealth Fund.

Muhondwa et al. (2008). Patient Satisfaction at the Muhimbili National Hospital in Dar es Salaam Tanzania. East African Journal of Public Health, 5, 67-73.

Watson, P.J. (2003). Improving Data Quality: A Guide for Developing Countries. Manila: World Health Organization

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