Surgical Services—present state— and how did we get here…..SIP 5 report 3/1/05 Renae Battie,...
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Surgical Services—present state—and how did we get here…..SIP 5 report 3/1/05 Renae Battie, Peter Buckley, Judy Canfield, Shelley Deatrick, Mark Schierenbeck, Helen Shawcroft
Surgical Services—present state— and how did we get here…..SIP 5 report 3/1/05 Renae Battie, Peter Buckley, Judy Canfield, Shelley Deatrick, Mark Schierenbeck,
Surgical Servicespresent state and how did we get here..SIP 5
report 3/1/05 Renae Battie, Peter Buckley, Judy Canfield, Shelley
Deatrick, Mark Schierenbeck, Helen Shawcroft
Slide 2
And then we started to grow. 1978 Addition of SCOR OR 15-16
1985 addition of OR 8-14 (13 shelled) 1990s OR 13, 17 opened 2001
Addition of OR 20 2002 R2 ASC opened with 2 OP ORs 2003
Nov--Pavilion Surgery Center opened with 6 ORs (5 shelled) (4 main
ORs closed) 2004 (Feb) 2 Main ORs using 2 Pav rooms 2005 (April)
Pavilion Short stay opens 7 new beds
Slide 3
UWMC Ambulatory Surgery Center at Roosevelt 2 OR ASC
Geographically separate from Hospital Ambulatory only Parking in
the basement Narrow spectrum - Eyes/Hands/ENT/Plastics Closed
Surgical Staff Unique/designated staff Unique leadership initially
Equipment - site specific Instruments shared Supplies shared
Sterilization off site
Slide 4
R2 ASC Retro fitted into existing Medical Office building
Planning start 10/00 Construction start 06/01 15 MONTHS Open for
business 01/02
Slide 5
JOINT CLINICAL PLANNING TASK FORCE - 1998 Charge: Identify and
evaluate program options for the 160,000 gsf pavilion. To Consider:
external factors, projected clinical growth service requirements of
the UWPN clinics, current effort to examine near-term options for
decanting ambulatory surgery volumes, impact of reductions in GME
support. Data Sources Analyzed: Current volumes Forecast future
volumes External environmental scan Experiences of other academic
medical centers Internal survey of potential need
Slide 6
JOINT CLINICAL PLANNING TASK FORCE (Contd) Recommendation on
core services to be included in building: - Ambulatory Surgery -
Pre-admission testing - Minor procedures - AM admit - Observation
unit List of other candidate programs
Slide 7
JOINT CLINICAL PLANNING TASK FORCE (Contd) Recommendation on
core services to be included in building: Ambulatory Surgery,
Pre-admission testing, Minor procedures, AM admit, Observation unit
List of other candidate programs Project Goals: Provide capacity to
meet increasing demand for services provided in an ambulatory
setting Provide significant additional OR capacity Provide a single
site for all surgery check-in Create an ideal patient experience
Provide an ambulatory teaching setting
Slide 8
PROGRAMMING COMMITTEE - 1999 - Robert Muilenburg, co-chair-
Mika Sinanan, MD, co-chair - Peter Buckley, MD - Rick Matsen, MD -
Judith Canfield - Al Moss, MD - Alex Clowes, MD - John Olerud, MD -
Mickey Eisenberg, MD - Jim Ritchie, MD - Jim Fine, MD - Bruce
Rothwell, DDS - Ben Greer, MD - Kathleen Sellick - Paul Ishizuka -
Dan Silbergeld, MD - Mike Kimmey, MD - Preston Simmons - Paul
Lange, MD - Ernie Weymuller, MD - Eric Larson, MD - Steve Wilson,
MD
Slide 9
PROGRAMMING COMMITTEE (Contd) Reviewed Joint Clinical Planning
Task Force work Solicited future plans and projections from
clinical services Reviewed demand forecasts for surgery (inpatient
and outpatient) Agreed upon building theme and occupants Agreed
upon sizing of OR suite, based on demand forecast and room
utilization model
Slide 10
PROGRAMMING COMMITTEE Vision Create a facility to compete with
the best in the region Create the ideal patient experience Create
the ideal faculty and staff environment Be the principal site for
ambulatory surgery Design for operational efficiency and
flexibility in patient care Create new academic opportunities for
programmatic development, education and research
Slide 11
PROJECT MANAGEMENT COMMITTEE Oversee final design and
construction phases of project Advise on budget/ project scope
issues Communicate about project progress to colleagues - Eric
Larson/Ed Walker, MD & Mika Sinanan, MD, co-chairs - Peter
Buckley, MD- Paul Ishizuka - Judith Canfield- Mike Kimmey, MD -
Patch Dellinger, MD- Tom Trumble, MD - Bill Ellis, MD- Barbara
Zuelzke
Slide 12
Functional Unit (OR)Forecast Methodology Workload Forecast X
Proc Length + Clean-up / Operating Hours/Year / Goal Utilization
Rate X Scheduled Procedures = Operating Room Forecast
Slide 13
Washington State Population Forecast Percentage Change Per 5
Years Annually ~1% Annually ~1.5%
Slide 14
King and S. Snohomish Counties Pop Projection 2000-2020 %
Growth % Change 2004-2015 = 11%, just over 1% per year
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Surgery Workload Forecast Currently for fy05
Slide 18
Surgery Caseload Forecast Currently at 14653 for fy05
Slide 19
Like Institution Benchmarks UWStanfordUCLAUSCUCSF Cases11,50 0
23,00021,00017,00010,000 ORs19334132450 Cases/ OR 600700500530450 %
OP47%59%43%24%21% IP Mins/ Case 235196255203247 OP Mins/ Case
11310378114109
Slide 20
WORKLOAD SCENARIO DEVELOPMENT
Slide 21
SUPPORT SPACE VERIFICATION
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Slide 23
Pavilion Services and Departments Third Floor Pre-Surgery
ClinicImaging Surgery ClinicGI/Endoscopy Second Floor 11 Operating
RoomsAM Admission OP Surgery Check-inSurgical Short Stay Pre &
Post Procedure Holding and Observation First Floor Urology
Clinic/Prostate Center Food Service/Conference Center Building
Support Services
Slide 24
Ready go--- Built from the ground up Planning start 05/99
Construction start 10/01 54 MONTHS Open for business 11/03
Slide 25
UWMC Surgery Pavilion 11 OR ASC using 6 ORs One floor ORs, two
floors Clinic /Endoscopy Connect to Hospital via skybridge
Ambulatory (70%), LS (15%), IP (15%) Sole site for DOS admits
Parking in the basement Broad spectrum practice Unique/designated
staff Unique leadership
Slide 26
Other Goals Increase sq footage of ORs increase # of ORs using
latest in technology infrastructure for digital age support next
ten years of development of technology and growth
Slide 27
What other changes with the new site? All preop patients in one
site Standardization of rooms, PLs, processes schedule boards
compliant with HIPAA automation of pharmacy and implants pleasant
environment for patients, families, staff create a new culture of
efficiency
Slide 28
Pre + Post Op Pre + Post Op HOME Patients pulled check by
system controller Patient Flow Admit to Hospital Admit to Hospital
Main Pre-Op Main Pre-Op OR OR Check-In Check-In OR OR Pre-Op
Procedure s Pre-Op Procedure s Straight Back Straight Back PACU
PACU AMBULATORY SURGERY MAIN OR
Slide 29
Whats the vision? OR
Slide 30
Standards for Pt flow Attentiveness to patient start times and
plan Parallel actions vs consecutive actions (next pt ready by end
of current case) Case prep done day before; minimal schedule
changes Pt preparation complete on arrival Comfort/flexibility of
shared tasks by team Adjusting amount of teaching time to goal of
on time starts Develop standardized, lean setup cases
Slide 31
Tracking Metrics On time surgical (starts within 15 min) Room
turnover (20 min or less) % surgeries completed as scheduled (95%)
Case cart accuracy (95% of all items present) Standardization of
care (50% reduction in case variation among top PLs) Patient
readiness (all ready at arrival) Patient wait time (less than 30
minutes wait)
Slide 32
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Stryker Integrated OR Information System- Endosuite Sony Video
Archiving System Pavilion OR Front Desk Conference and
teleconference Sony video archive
Slide 34
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UWMC OR Forecast
Slide 36
R2 ASC opens Jan Pav SC opens Nov.
Slide 37
R2 ASC opens Jan Pav SC opens Nov.
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Anne x opens Short stay opens
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4NE Midnight Census Trends September 2004 August 2004 October
2004
Slide 48
4NE Midnight Census Trends December 2004 November 2004 January
2005
Slide 49
4NE Midnight Census Trends February 2005
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* Annualized
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Visionor Hallucination? Exceptional leaders cultivate the
Merlin- like habit of acting in the present moment as ambassadors
of a radically different future, in order to imbue their
organizations with a break-through vision of what it is possible to
achieve. Charles E. Smith, management consultant