Hospital operating rooms (ORs) are typically high cost centers—as well as potentially high revenue centers. Most hospitals charge OR time by the minute, so there is tremendous pressure to make peri-operative services as efficient as possible. The incentive toward efficiency was heightened throughout the U.S. in the mid-2000s, as insurance and Medicare reimbursements dropped significantly.
Central Maine Medical Center (CMMC)—a large general medical hospital and three regional affiliate hospitals serving a population base of nearly half a million people in central and western Maine—sought to build capacity within its surgery division without raising labor costs. Efficiency studies that tracked patients through every step of their surgical experience at CMMC revealed that poor communication among hospital staff members was creating unnecessary delays in processes.
Since implementing the Vocera® Communication System in 2011, CMMC has seen dramatic increases in the efficiency of its surgery department. The hospital has used the voice-driven, hands-free Vocera Badges to create an additional 350 hours of annual OR capacity while saving more than $300,000 in yearly labor costs.
Slow Responses Diminished OR Efficiency
“Walkie-talkies, beepers, and overhead paging were the traditional communication technologies in place. None were effective at getting answers to questions, or finding people or specialized pieces of equipment, when they were needed,” said Bruce O’Donnell, Chief Nurse Anesthetist and the administrator in charge of CMMC’s nurse anesthesiology department. “We knew we had a major internal communication problem that we needed to address.”
The issue was not the volume of communication—the top six surgical division team members were receiving more than 750 pages a month—but its effectiveness. For instance, each of those pages had an average closed-loop cycle time of three minutes, and sometimes a number of pages would have to be exchanged to get an answer to a simple question.
The communication problem translated directly into delays in nearly every step that surgical patients took in their time at CMMC: from admissions into the hospital, through pre operative, OR, and post-operative areas, through recovery time and finally release from the hospital.
To address their communication issues, CMMC considered giving everyone in the surgery department a walkie-talkie-like solution from Nextel, but that system’s satellite operation created security and patient confidentiality concerns for the hospital’s IT staff. The IT department rejected the use of cell phones for the same reasons.
Vocera Streamlines and Simplifies Communication
“We chose the Vocera System because it is wireless and operates inside the hospital over the hospital’s wireless infrastructure. It alleviated the security and privacy concerns of other open network approaches,” said O’Donnell. “Vocera makes it easy for hospital staff members to communicate with each other instantaneously.”
CMMC deployed the Vocera System and distributed Vocera Badges to staff members throughout the hospital’s surgery division, which encompasses 24 beds for same-day surgery and admission; a 5-bed holding bay for pre-op; 16 OR suites on 3 different floors; and a 10-bed PACU (postanesthesia care unit) suite. They deployed Vocera as a “pyramid” with the staff, starting with runners such as orderlies, the room turn-over teams, and then the anesthesiology department.
“With Vocera, we can immediately get an extra set of hands to help with a patient in the PACU, or quickly locate specialized equipment that might be in a different end of a wing or on a different floor,” O’Donnell said.
Delivering Quantifiable Improvements
CMMC’s administrators insist on measurable bottom-line results in all aspects of the hospital’s operation. “When the CFO signed off on the capital expense for Vocera, he demanded that we provide data points at the end of the first year of deployment,” O’Donnell said. Because the hospital already had SIS (Surgical Information System) electronic medical record (EMR) tools in place, they could compare productivity, delays, and other metrics before and after the Vocera deployment. “We had tons of data, we just needed to mine it.”
Highlights of CMMC’s analysis, comparing essentially the same patient volume in FY 2010 (pre-Vocera) to FY 2011 (with Vocera):
• Increased capacity was created in the surgical department through a 26% decrease in high-impact delays (as identified by team leaders); a 2.6% drop in average length of each surgical case (responsible for opening up 350 hours of capacity); and a 2.7% decrease in the total time spent on surgical division procedures for the same number of cases.
• Productivity improved 9%.
• Labor costs were lowered by more than $300,000, by decreasing FTEs (full-time equivalent workers) and paid hours by 11.6%.
• Communication time decreased as measured by a 93% plummeting of beeper pages per month—which at 3 minutes per page, cut 35 hours of communication time per month.
O’Donnell identified four additional areas where Vocera has provided unexpected benefits:
• Safety—Nurses and other healthcare professionals on staff can get help with patients almost instantaneously, without leaving the patient’s side. Instead of minutes being wasted in finding or remembering beeper numbers or waiting for pages to broadcast and be answered, with the Vocera System a specific person can be called to help in mere seconds.
• Broadcast ability—Vocera lets the CMMC staff reach groups of individuals all at the same time, simply by saying the group name into the Vocera Badge. “This capability saves an enormous amount of time when you don’t have to dial each person in the group one at a time,” said O’Donnell. The ability to broadcast with Vocera also makes it easy to find shared, specialized equipment. Rather than sending someone from room to room to look for a glidescope, for instance, “Vocera lets you press a button, broadcast that you need a glidescope in Room 3, and you get an immediate response: ‘I’ll bring it right over,’” he said.
• OR flow—ORs demand lots of staff besides the surgeon, including the anesthesiologist, scrub nurses, circulating nurses, orderlies, and other surgical assistants. “These staff members are not on leashes and must be mobile. If an operation does not start on time, everyone disappears to do other things,” said O’Donnell. “Rounding them up again used to take lots of time. With Vocera, you can say, ‘Report to OR 4 for immediate surgery’ and all the appropriate people know to take their places right away.”
• Answering simple but important questions—“Let’s say the admitting ward needs to tell an anesthesiologist that a patient’s blood sugar results are out of whack, so anesthesia needs to be postponed or recalculated, which could impact the OR schedule for the whole day,” said O’Donnell. “Previously, that simple exchange might have taken 10 or 15 minutes, by the time the admitting clerk tracked down the anesthesiologist. With Vocera, the whole conversation can be completed in well under a minute.”
While O’Donnell has not conducted a formal employee satisfaction test on Vocera, he said, “I know I would have a mutiny on my hands here if I ever tried to remove it. And other departments are now clamoring for the system: respiratory therapy, lab, emergency department, ICU (intensive care unit), and radiology.”
O’Donnell appreciates the Vocera System for another, more personal reason, as well. “The president of the hospital has made it clear that in these times of financial crunch, it is important that people be responsible about capital purchases,” he said. “Because I was the one pushing for the Vocera System, I became accountable for its performance. The fact that we were able to prove quantitatively that it did what it promised to do, I now have more credibility for the next time I want to make a request.”