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| June: Featured Story Providence St. Vincent Medical Center – Surgical Services Overview: Considering the size (53 Pre/Post-Op beds, 27 ORs, and 27 PACU beds) of the new Surgical Services facility, the fact that the expansion would be staged in two phases, and the complexity of running an operation with multiple inputs and constraints, it was determined that the use of discrete event simulation modeling was the only way to get a prospective look at how certain decisions would impact operations, enabling PSVMC to identify, test out, and quantify which implementation ideas would work the best. PSVMC experienced a successful engagement with ProModel Healthcare Solutions that included creating a comprehensive computer generated simulation model to help plan patient flow, determine optimal case placements, and identify preferred staffing models. The project was implemented in 2 phases to meet PSVMC’s facility move-in schedule. Phase I – Tested & evaluated the following considerations to ensure successful transition to one-half of the new Pre/Post-Op and PACU areas: • Impact on new facility of case volume adjustments
Results: Phase II – Tested and evaluated various case assignment models to determine how to best incorporate the current day surgery cases into the new Main OR and open up the entire Pre/Post-Op area: • Evaluated case specialties and case acuity to develop a plan that allowed for better efficiencies and a decreased need for open rooms later in the day • Determined the best utilization for two ORs with close proximity to the Pre/Post-Op area • Identified best Pre/Post-Op location for pediatric patients • Determined best nurse assignment models for Pre-Op and Post-Op care • Identified impact on patient wait times as related to staff allocations/reductions Results: Identified preferred patient flow model where patients were assigned to Pre/Post-Op beds, based upon assignment to a specific Core/OR, and nurses were assigned to patients based upon the OR assignment: • Decreased the amount of time a patient had to wait pre-operatively to be seen by a nurse • Allowed patients to be admitted upon arrival to the hospital, reducing start-up bottlenecks and improving customer satisfaction • Increased the percentage of patients ready 30 minutes prior to scheduled procedures • Decreased delays in patients going from PACU to Post-Op • Allowed management, staff, and physicians to see prospective data on how patients would flow in the new facility – assisted with “buy-in” and acceptance before moving in to the new facility • Defined nursing assignment scenarios and assessed for impact, including assignments by: OR Core, patient type, zone, etc. Futures: Given the complexity, flexibility and accuracy of the model, PSVMC plans to continue to use it to make plans for on-going volume adjustments due to the opening of both an outpatient orthopedic surgery center and a pediatric surgical unit. They also plan to evaluate their case scheduling process, determine needs for additional pieces of equipment and instruments, and determine the impact of having individual surgeons alternate cases between two rooms. Summary: Ensuring optimal performance in a complex and highly interactive environment
is challenging and often requires substantial process change, which unto
itself can be difficult and not without controversy. The best way to
identify optimal solutions, and then demonstrate the rationale for change-decisions
with administrators, physicians and other staff is with numbers…scientifically
accurate numbers. With the ProModel simulation solution, PSVMC was able
to quantitatively and graphically compare current practice to alternate
scenarios to generate a compelling case as to why the solutions recommended
were right for the department. In addition to improving overall performance,
they were able to show how the move to the new facility would positively
impact each stakeholder, including patients, through reductions in wait
times and Length of Stay.
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