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Timing is Everything in the OR.

Surgery scheduling system captures charges and manages time.

Virtually every surgical services department faces the problems of scheduling, uncaptured charges, and long turnaround times between cases.

At Danville Regional Medical Center in rural southern Virginia, we perform more than 8,000 surgical procedures each year. About 60 percent of those are Medicaid/Medicare cases, so cost containment is a major concern for us. We found ourselves losing thousands of dollars annually because of a variety of problems such as:

* Uncaptured charges. Our manual system of charge capture was causing us to lose tens of thousands of dollars in uncaptured charges annually.

* Turnaround time. Our staff was spending as much as 40 minutes between cases, which limited our productivity, and frustrated our surgeons and patients.

* Information. There was a lack of complete and timely information to aid in effective scheduling, purchasing, and resource assignment decisions (for instance, procedure times by specialty, comparison of costs by surgeon, and other reports).

* Data entry. We had one employee spending hours every morning compiling stats from the previous day--such as procedure times by surgeon, specialty, and other factors. Because we were required to get this information in by noon, we had to keep this person focused on this task and nothing else during the morning hours. This meant we essentially had one less person available to handle a multitude of other tasks that needed to be done.

* Determining costs. Because we didn't have a comprehensive reporting system, it was impossible for us to determine cost per case, by procedure, or by surgeon. It was extremely difficult for us to convince a surgeon that his supply cost per case was higher that that of his peers. Consequently, the cost of some of our procedures was much higher than necessary.


To solve these problems we purchased ORSOS[TM], an enterprisewide surgery scheduling and resource management system from Per-Se Technologies, Inc. The system automatically manages all of our surgical staff, equipment, and inventory using a engine that considers all of the clinical, financial, and operational criteria that must be addressed for each surgical event. By using the system, we're assured that every procedure is supported by the most appropriate resources and occurs in the most effective time and place.

To address the issue of uncaptured charges, we also implemented the ORSOS Revenue Maximizer and Charge Interface. With this component, nurses use automated preference cards to check off any unused items and add additional items to the case.

This information is electronically passed on to the patient accounting system, saving the nurse from having to key as many as 100 items into an inventory system and a patient accounting system.


The ORSOS software and associated interfaces cost about $100,000. In addition, we've purchased two additional expansion components, Perioperative Charting and Big Board, at a combined software cost of $70,000.


Hardware: Gateway server

Software: Per-Se Technologies' ORSOS 8.5.1.

Training: We received hands-on instruction at Per-Se Technologies' Chapel Hill office.


Savings: We've reduced the number of full-time employees in the operating room by 12. We've seen a 27 percent increase in captured charges as a result of Revenue Maximizer/Charge Capture. The money we've saved has enabled us to purchase the newer supply items that the surgeons have requested.

Productivity: We've reduced downtime between cases by 30 percent, which has enabled us to take on more cases. And, because we have access to more complete, accurate data, we've been able to achieve much better utilization of equipment and resources.

Patient care or service: The system compiles information such as procedure times by surgeon, specialty, etc., in a matter of minutes, freeing up staff to spend time on activities that more directly impact patient care and revenue generation.

By significantly reducing downtime between cases and having comprehensive reporting mechanisms in place to show how long procedures will take, we've fine-tuned our scheduling so that patients don't have to wait as long for procedures to begin. This is important in creating a positive patient experience.

New reports: The system also helped us generate reports not available to us in the past. Some examples:

* Cases by provider by date range: This shows the number of cases each provider has done, the type of cases and the dates they were performed. This is very useful in physician and nurse recredentialing.

* Cases after 3 p.m. and before 7 a.m.: We were trying to determine whether we needed to boost staffing after 3 p.m. By running this report, we found that our case load after 3 p.m. was up 23 percent over the previous year. This gave us justification to run a full schedule until 6 p.m. and add 6 1/2 full-time employees.


After performing benchmarking procedures to compare our efficiency against 600 other hospitals, we found that our OR department performed better than most in the areas of time, labor expense, and total expense per case.


We are upgrading to ORSOS 8.5.2 release and adding two ORSOS components: Perioperative Charting and Big Board. Perioperative Charting will enable nurses to enter chart information electronically as events occur, right at the point of care. This should eliminate a lot of overtime from a clerical standpoint. Big Board provides an airport-style monitor of the status of OR activity.


For more information on Per-Se Technologies, circle 175

John Carter
Operating Room Business Manager
Danville (VA) Regional
Health System


Per-Se Technologies, Inc.
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Title Annotation:Company Operations; Danville Regional Medical Center's enterprise-wide surgery scheduling and resource management system
Publication:Health Management Technology
Date:Apr 1, 2000
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