Enhancing Surgical Care in BC - British Columbia Medical Association

Health Integration Networks (LHINs), and individual hospitals to monitor and compare progress and help identify,
analyze, and improve on areas where performance issues exist. LHINs are also able to link perioperative performance
with surgical program funding.
Exhibit 4. Ontario’s Surgical Performance Indicators
• % First Case On Time or Early
• % Subsequent Case On Time or Early
• Average Patient-In to Patient-Out Minutes
• Average Patient-In to Anesthesia-Ready Minutes
• Average Turnover Minutes
• % Scheduling Accuracy
• % Utilized 7 a.m. to 3 p.m.
• % Same Day Add-On Weekdays
• % Unplanned Closures
• % Same Day Cancelled or Postponed
• % Returns to Surgery Within 24 Hours
• % Patients Screened Prior to Surgery
• % Surgical Checklist/Timeout Compliance
• % Priority Cases (various)—Access Within 0–2 hours, 2–8 hours, 8–48 hours, 2–7 days
Perioperative coaching teams were also established to provide assistance to 61 hospitals that requested peer support
from the coaching program. Each coaching team comprised a physician expert (surgeon or anesthesiologist), one
or two surgical leaders (vice president or director), and one or two perioperative leaders/managers. Coaching was
provided to help hospitals conduct self-assessments of their perioperative processes and develop improvement plans
to address key practices highlighted as part of the SPAI Expert Panel recommendations. The role of the coaching teams
was seen as an invaluable and successful resource because the teams were made up of peers and supported hospitals
to lead their own improvement initiatives. Coaching was also seen as an opportunity to share best practices, tools, and
templates (Berk, Hall, & Legresley, 2010; Sherrard, et al., 2009).
Based on a preliminary assessment of the coaching teams and the best practices identifi ed in the SPAI Expert Panel
report, all hospitals reported improvement in perioperative effi ciencies, increased surgical capacity, incurred savings,
and improved the quality of care (Sherrard, et al., 2009). Some of the specifi c achievements identifi ed by some hospitals
include the following:
• Reduced cataract surgery wait times by 18% within one year, with further reductions continuing.
• Increased surgical throughput for cataracts with reduced wait times by 76 days by creating an aide role in the
cataract suite and improving processes.
• Earlier discharges and reduced lengths of stay from 6.2 to 5.4 days for hip replacements and from 5.5 to 5.2 days
for knee replacements.
• Number of cancelled procedures due to bed unavailability reduced by almost half, from 24 cancellations to 14.
• Saved $100,000 by revising the supply chain and inventory processes.
23 Enhancing Surgical Care in BC – Part 3: Process Improvement Initiatives in Other Jurisdictions