BPR at Surgery Dept.

Singapore Hospital

Camille Armand (193) Abhijeet Kr. Sinha (001) Amrit Pati (007)

Arnav Nandy (012) Bikash Ranjan Sahoo (018) Debadutta Patro (021)

Introduction
Singapore Hospital department of surgery 21 operating theatres (OT): - 19 for elective surgery (8h/day) - 2 for emergencies (24h/day) Daily reservations of the OT for a specific clinical discipline: - some OT are exclusively reserved for some disciplines - others free to be used by any other disciplines The simulation is based on only 8 OT to make it simple (8 categories of surgery)

Overview of the problems faced by the department of surgery

Rise in healthcare costs in the last 30 years
rise in the department expenditures

Increase in the demand of surgery services in the last 20 years

+ Lack of manpower in the sector (low doctor-to-patient ratio) Each OT reached a high rate of utilization
the department has to deal with it and optimize its current resources to improve the efficiency and effectiveness of the OT utilization + they have to keep in mind to provide quality services

Problems, possible solutions and outcomes

1. 2. 3. Elective operating theatres operate from 8.30 to 17.30. There are delays due to complexity of surgery or operational delays. Solution prescribed: Implementation of shift system Each operating theatre was reserved for a specific clinical discipline. Solution prescribed: Declassifying the operation theatres 19 of the 21 operation theatres were allocated for elective surgery. When there was an increase in emergency cases, they needed to be scheduled in some other elective operation theatre thereby affecting the scheduling. Solution prescribed: Better scheduling system, More emergency operating theatres Orthopedic surgery creates a bottle neck due to its high pre-operating area time. Solution prescribed: Model 3 with the declassified operating theatres. As they reduce the wait time in the pre-operating area to 69% from 90%. System efficiency also went up to 64.8% Specific surgeons with certain surgical specialties are highly utilized. Same for the anaesthetists due to their work in the pre-operative and postoperative processes. Solution prescribed: collect data on a regular basis and review theatre utilization periodically

4.

5.

O.T. PROCESS FLOWCHART

Arrival Pre-Op O.T. Setup

Summon to O.T.

Shift to recovery cabin

Surgery

Shift to O.T.

Original Model
PATIENT
Register
Single Shift 08001800 hrs

STAFF (X)

SURGEON (Y)

ADMIN
Approve

Arrive

Schedule

Pre-Op
Setup Exclusive OT
Shift on Gurney to OT
Shift for Recovery

Summon to Exclusive OT

Surgery
Exclusive OTs

Misc Processes

Exit

Model #1
PATIENT STAFF (X/2) SURGEON (Y/2) ADMIN PATIENT STAFF (X/2) SURGEON (Y/2) ADMIN

Register

Approve

Register

Approve

Arrive Pre-Op
Setup specific OT Shift on Gurney to OT

Schedule

Arrive Pre-Op

Schedule

Summon to OT

Setup specific OT Shift on Gurney to OT

Summon to OT

Surgery
Exclusive OTs

Surgery
Exclusive OTs

Exit

Shift for Recovery

Misc Processes

Exit

Shift for Recovery

Misc Processes

Model #2
PATIENT STAFF (X/2+) SURGEON (Y/2+) ADMIN PATIENT STAFF (X/2+) SURGEON (Y/2+) ADMIN

Register

Approve

Register

Approve

Arrive Pre-Op
Setup specific OT Shift on Gurney to OT

Schedule

Arrive Pre-Op

Schedule

Summon to OT

Setup specific OT Shift on Gurney to OT

Summon to OT

Surgery
Exclusive OTs

Surgery
Exclusive OTs

Exit

Shift for Recovery

Misc Processes

Exit

Shift for Recovery

Misc Processes

Model #3
PATIENT Register STAFF (X/2+) SURGEON (X/2+) ADMIN Approve PATIENT Register STAFF (X/2+) SURGEON (X/2+) ADMIN Approve

Arrive

Schedule

Arrive

Schedule

Pre-Op
Setup OT

Pre-Op
Allot OT
in FCFS mode

Setup specific OT

Allot OT
in FCFS mode

Summon to OT
Shift on Gurney to OT

Summon to OT
Shift on Gurney to OT

Surgery
Misc Processes

Surgery
Misc Processes

Exit

Shift for Recovery

Exit

Shift for Recovery

Discussion and Conclusion

The simulation model was run for 168 hours (7 days), with a warm-up period of 48 hours, with 20 replications
Locations : Entrance, Pre-Op, Recovery, Exit, Specialty OTs. Resources : Gurney, Anaesthetist, Surgeon.

Specialty Operating theatres : Highly Utilized Specialty Surgeons : High Demand Anaesthetists : Highly Utilized Declassification of OT
Utilization of Pre-operating area reduced from 90% to 69%, i.e., bottleneck improved. Efficiency improvement from 45.6% to 64.8%. Total no. of Exits almost doubled. Total number of failed arrivals reduced by 28%.

Queries?

THANK YOU