Smoothing Patient Flow Offers Multiple Work/Life Benefits for Surgeons

The topic of work/life balance is one that is near and dear to most people’s hearts, particularly surgeons. And according to a 2003 study published in the Annals of Surgery, which predicted a 50 percent shortage in some surgical specialties combined with an increased demand for surgeries, that work/life balance could become more precarious.

“Hospitals, in trying to capture a physician’s business, are doing whatever they can to make the physician happy,” says Christy Dempsey, senior vice president of clinical operations for PatientFlow Technology. “If he wants to work on Tuesday, they let him work on Tuesday. The problem is, if he’s an orthopedic surgeon and there’s a bunch of other orthopedic surgeons [operating] on Tuesday, what you’ve really done is made his life more difficult.”

Identifying the problem

William Mayfield, MD, a board-certified thoracic and cardiovascular surgeon at WellStar Kennestone Hospital, Marietta, GA, has been practicing for 20 years. He points out that hospital operating rooms, taking into account surgeons and administrative staff, are surrounded by pretty smart people. However, the same question has been asked ever since Mayfield has been practicing: Why does it take so long to get a patient in the OR?

“No one has ever been able to offer any comprehensive answers,” says Mayfield. “There’s never been any science around it. You put your finger in the dike here, and it leaks somewhere else, so you put your finger in the dike there.” Those dike-plugging tactics usually result in a negative domino effect. Too many scheduled surgeries result in delays getting patients into the operating room. Patients post-op are not going to the appropriate floors in the hospital, and the delays are causing physicians to be late for clinic, prompting patients to wait beyond their scheduled appointment times.

PatientFlow, however, offered WellStar a solution. The company uses the science of operations management, separating elective and non-elective volume of patients and smoothing the elective volume to eliminate artificial variability and manage natural variability. According to Dempsey, by providing more predictability for physicians, patients get to the operating room when they need to, and they wind up in the right bed every time.

And it works

Mayfield admits that he was skeptical at first. So he asked, “Are you telling me that you can give me the right patient in the right room at the right time with the right resources?” The answer was “yes,” and the results have included a 21% drop in surgical wait times. “You can more accurately predict the time you’re going to start, and the time you’re going to be finished, thereby you’re able to plan your life a little better, in the office and at home,” says Mayfield. “My partner and I just finished seven cases, four of which were add-on, and it’s 6:20 p.m. and I’m about to head home. Two years ago I would have been finishing around 11 p.m. That’s a huge difference.”

Ken Larson, MD, trauma surgeon and medical director for St. John’s Burn and Wound Center in Springfield, MO, has also seen the benefits of PatientFlow Technology, though he admits he was a naysayer at the start.

“Christy [Dempsey] came to us and said, ‘You guys need to give up one of your blocks, and we’re going to make things better by using it as an add-on room.’” Larson recalls. “And because block time was so precious here, I said, ‘You’re nuts.’ So, I got on the committee as the you’re-nuts, you’re-not-going-to-do-this-to-me guy, but it actually did work out very well. We saw our revenue go up about 10 percent, and it enabled us to run our clinics smoother. We weren’t missing clinics, either.”

Change isn’t easy

Larson explains that in order for PatientFlow to work, physicians and their colleagues—including those in administration and anesthesia—have to be willing to change. They have to be willing to make a leap of faith. Otherwise, there may be only marginal improvement.

“We saw that when you start putting patients on the right floor, you see them go home quicker,” says Larson. “They get better care, and the length of stay goes down. You put the ortho patient on the GYN floor and they’re going to be there about a day longer.”

Mayfield agrees, and says that “everyone has to give something up.” As an example, he explains that if three joint surgeons are doing all their surgeries on Monday and Tuesday, they’re going to exceed capacity for their unit those days and the operating rooms are going to be empty over the weekend. For PatientFlow Technology to work, he says, someone is going to have to move their operating days.

“That means you’re also going to have to move your office, which is going to affect your secretary and your nursing, so there is some pain involved,” Mayfield admits. “Is it perfect? No, but the bottom line is it’s a better way to take care of patients.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at edwardr@ptd.net.