The future of operating room organisation

28 October 2017



A new app-based system for organising operating room (OR) resources is leading to significant improvements in OR block management at UCHealth’s University of Colorado Hospital. Steve Hess, chief information officer for UCHealth, tells Lynette Eyb how the smartphone technology is leading to more efficient use of ORs for surgeons, OR staff and patients.


A new operating room (OR) smartphone app being used at UCHealth’s University of Colorado Hospital in the city of Aurora has seen a 16% efficiency improvement in the management of the hospital’s OR blocks in its first three months.

In May 2016, UCHealth – a nationally recognised, non-profit network of eight acute-care hospitals and more than 100 clinics throughout Colorado, southern Wyoming and western Nebraska – partnered with LeanTaaS, a Silicon Valley healthcare analytics company. The goal was to manage OR blocks – the time allocated to particular surgeons for various procedures – more efficiently.

The solution was the introduction of iQueue, an app-based system that leverages OR data. It analyses utilisation patterns and recommends block schedule changes based on hard facts.

There are 38 inpatient ORs at the health system’s academic anchor, the University of Colorado Hospital, alone. Increasing efficiency across ORs was therefore seen as key to making better use of hospital resources and improving patient outcomes.

“The operating rooms are the most expensive piece of real estate within any health system,” explains Steve Hess, chief information officer for UCHealth. “OR scheduling is the art of aligning surgeon availability, patient availability, room availability, equipment availability, and nursing and support staff availability. Any delays, or less-thanoptimal use of the OR, have a cascading impact on other patients and their surgeries, whether emergent or elective.”

The more efficient the OR schedule, the greater the chances of finding space for emergency procedures without a severe knock-on effect across the OR.

“The iQueue for OR product works to take the art out of the process and make it more scientific,” Hess says. “We can use past data to predict and prescribe future needs at surgeon and room level. With a more redictable schedule, we can forecast equipment and staffing needs, and we can accommodate the emergent surgeries that arise, along with the elective surgeries. It is applying graduate-level math to a graduatelevel problem.”

Hess says the system has increased visibility of OR efficiencies, bringing real-time data analytics to the attention of OR staff and management.

Following the app’s initial success, UCHealth expanded iQueue to operating rooms in hospitals across the health system. So far this year, UCHealth has deployed iQueue across 86 rooms at different stages in its hospitals, not only in the Denver area, but also in northern and southern Colorado. Within 25 ORs at the University of Colorado Hospital’s Anschutz Inpatient Pavilion (AIP), six-month room utilisation has seen an increase of 6.5% – rising from 71.8 to 76.5%. The AIP was also able to accommodate 12 new surgeons with individual blocks and give them time.

Advantages of the system

This applies a proactive approach to resource management. It mines case data and analyses utilisation patterns to forecast volume, and predict who might need more/less time, and when.

It provides detailed visibility of OR utilisation patterns, and has web and mobile dashboards that show exactly how OR time is being used. It highlights potential improvements, such as indicating those surgeons who aren’t using their allocated time efficiently, or how to accommodate block requests more fairly.

The programme also enables easier and more convenient block exchanges. The system continually looks for abandoned blocks that may have gone unnoticed and makes them available for surgeons and surgeries.

Hess says the system gives surgeons and other OR staff more control over their scheduling, allowing them to release or request blocks more easily. It allows new surgeons joining UCHealth to fit seamlessly into the OR schedule, and increases the predictability of nursing or OR support staff availability. It also improves the chances of patients having elective surgery at a time that suits them.

Up to now, Hess sees no major drawbacks to using the system. “The cons aren’t really any cons, rather, they are change management items that need to be considered. Like most technology, there are people, process and tool considerations. These three elements need to be harmonised to drive maximum benefit. These tools are just tools – if the people and processes don’t adapt with them and help provide feedback to make the tool better, it won’t be used to its full effectiveness.”

Above and beyond

According to the makers and product users, the technology can be easily adapted for use in other healthcare environments internationally.

“As long as the health system has a way to collect OR utilisation data and case-log information, and has an electronic OR scheduling system, there are no other requirements needed to use iQueue for OR work,” says Hess.

The system is a joint initiative between UCHealth and LeanTaaS, which analysed several years’ worth of data from historical OR scheduling and case logs to create predictive algorithms.

Hess says the system gives surgeons and other OR staff more control over their scheduling, allowing them to release or request blocks more easily.

These were then tested with current data to determine how well they predicted OR volumes, surgeon needs and room use. The algorithms were iterated several times and continue to be optimised to provide up-to-theminute analysis.

More than 40 healthcare providers in the US are now using the LeanTaaS iQueue system.

Sanjeev Agrawal, president and CMO at LeanTaaS, said the company took a common-sense approach to improving OR efficiencies.

“We started out by asking, ‘how can we leverage data and smartphones to make OR block scheduling easy, transparent and fact-based?’ The answer was to first mine OR case data and use machine learning to understand utilisation patterns, and then to create lightweight mobile interactions that provide timely, actionable alerts and facilitate seamless block exchanges. We’re excited about the initial results at UCHealth and look forward to many more improvements in the future.”

Hess says the introduction of the iQueue system at UCHealth is just the first step towards better use of technology, but he stressed that using data-led technology meant looking beyond the numbers to fully understand the data.

The system’s actionable dashboards explain the ‘why’ behind the metrics, he says. “The ability for artificial intelligence and machine learning to impact care is almost limitless.

“Over the past decade or so, healthcare systems have made significant investments in healthcare IT, such as electronic health records. With that, healthcare systems now have access to data they never dreamed of previously. But it comes with the potential downside of not having the time or the knowledge to use that data to impact positive change. We can see what happened, but don’t know why or how it happened. With this tech, predictive and prescriptive capabilities are at our fingertips. Complex systems such as healthcare need complex capability to make sense of what we are doing, and what amendments can be made to change our destiny.”


How iQueue works

  • Surgeons receive a weekly text message with their latest OR metrics showing how they are using their time and contributing to OR volumes.
  • Based on their own schedule, surgeons (or their schedulers) can request and release block time anywhere, anytime, directly from their phones.
  • OR managers get a 360° view of metrics without having to collate any of the data themselves.
  • OR managers can make block changes easily and transparently for other colleagues to see and be aware of.
  • Surgeon schedulers can request and release block time for their surgeons without having to send emails or make phone calls to confirm surgeon, equipment or patient availability.

What are the causes and effects of delays in the OR?

  • Perioperative areas are the most costly to operate in a hospital and account for more than 40% of expenses.
  • Costs are 2.5 times higher for hospital stays that involve an OR.
  • In several studies, delays were exacerbated by general surgeons underestimating the time required for procedure by 31 minutes.
  • A BMJ study suggests that anaesthetists are the most inaccurate (underestimating by 35 minutes), and highlights the potential differences between specialties in what is considered part of the ‘anaesthesia time’.
  • A UK study lists the reasons for surgery delays as: patient unfit (33.0%), lack of beds (21.7%), and a lack of theatre time (17.3%).
Source: Duke School of Nursing, BMJ and the International Journal of Surgery

iQueue analyses OR data and recommends block schedule changes based on these facts.
Steve Hess has been working in the healthcare IT field for over 25 years, and has been chief information officer of the University of Colorado Health (UCHealth) since 2012. His team focuses on implementing consolidated and standardised IT systems across all UCHealth hospitals and clinics.
Ineffective OR scheduling can have severe knock-on effects that impact on patients and their surgeries. Using the iQueue app minimises these, and makes better use of hospital resources.


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