Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward.

Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole. And today, we're highlighting OR delays. Joining me is Dr. Napoleon Player. He's the Associate Vice President of Perioperative Services and Procedure at UAB Medicine. Dr. Player, it's such a pleasure to have you join us today. And as I understand it, you are relatively new to UAB Medicine. So, tell us a little bit about yourself and how you came to UAB.

Dr. Napoleon Player: Yes. So, thank you for such a great opportunity to get out into the community in the UAB Medicine space. Super excited for this chance. So, a little bit about myself. I did a lot of my medical career in Louisiana and Texas and had an opportunity to kind of see UAB in the periphery, and then had the opportunity to start to partner with a search firm and they highlighted some of the amazing things that UAB has done and want to do in the future. A lot of the great integration work that we're doing here and just the pillar in the community that UAB is has always been exciting to me in the Birmingham area.

So, super fun things that we're doing. And I wanted to come here and continue to work on things like the topic that we're talking about now, which is OR efficiency and excellence. And that's a background that I've always had. I've spent twenty plus years in the nursing field and also helping run operating rooms in some large academic medical centers.

Melanie Cole, MS: Thank you so much for sharing that with us. So, what are some of the most common causes of OR delays in today's healthcare environment that you've seen? And when we think of efficiency and excellence, these delays are counterintuitive to that. So, tell us a little bit about it.

Dr. Napoleon Player: Yeah. So, operating room efficiency has a lot to do with the access. And there's a couple of different pillars that you find that patients will fall into. They're either usually patient-related type of late arrivals, provider-related, you know, surgeon anesthesia, some of your procedural teams maybe did not get the full preoperative assessment, scheduling conflicts. We usually have equipment and supplies that's where you're missing just the unavailable instruments during processing delays, equipment malfunctions, which are rare, but sometimes implant specialty. You have room turnover like the case before. They maybe got into some difficult anatomy and, you know, we booked a four-hour spot and it turns into five.

Of course, we always focus on our patients. And, you know, want to give them the time and attention needed there. And so it may run that other case over. We do see that, frequently in many operating rooms. And then, overall communication is always one of the things that we see causes delays. We do a lot of multi-surgeon surgeon type of procedures here. We do very complex cases at UAB, where maybe two different surgeons are having to operate. We have a huge robotic fleet here. And so, that causes us to do just very complex cases. And so, those multitude of things can cause delays, just coordinating all of that. Running an operating room is very much like the airport. It's busy, a lot of things, a lot of moving pieces, and a huge fleet. The UAB campus, the operating rooms are spread across just in the downtown area, several city blocks. And then, we have multiple sites that are incorporated into our UAB Medicine, operating room, preoperative medicine suite. So, very complex environment, a lot of moving pieces that we have the opportunity to kind of put together and sync those up.

Melanie Cole, MS: That was a great description of it. So when we think of syncing that up and these delays, what are some of the truly unavoidable reasons for this? When we look at what we can control and what we cannot control, tell us a little bit about those ones that are just unavoidable that are maybe just going to happen.

Dr. Napoleon Player: Yeah, very much excited to talk about that. So, we have the opportunity of being the level one trauma center for all of Birmingham and all of Alabama as well. And with that being said, we do a lot of emergency and trauma cases. Those are totally unpredictable. We have the ability to have operating rooms always readily available.

And with that, that just has unexpected case volumes that come along. And we try our best to never bump elective cases, but sometimes we have to rearrange those. We understand that that is completely inconvenient for someone who's been maybe fasting for a while or just that anxiety of ready to get into the operating room and the families behind that.

And so, those are some of the ones that are very unavoidable and just unforeseen surgical complexity. You start and you had a mission of completing one type of operation. And then, you get in and you see that it's a little bit more complex, and we need a little bit more time. So, we always want to focus on that and give our surgeons that opportunity to continue to provide the best level of care. And there's just some things that are unforeseen. I don't care how much diagnostic testing you do or just the things that we do in partnering to prepare to get a patient ready for the operating room. We kind of come at the operating room, like I told you, very much from an airport type of situation where really behind the scenes gets you what I kind of call a boarding pass to say that the patient is completely ready from insurance verification to radiological images and just different lab tests.

And so, all of that becomes very complicated. And sometimes, any of that stuff that gets off really is truly unavoidable. You need to pause and make sure that the patient is optimized for surgical care.

Melanie Cole, MS: Then based on that, which ones are preventable? Because obviously, as you say, as a trauma center and these traumas come in and that's going to push everything back or you find something you didn't expect. But what about the preventable ones? Like you even mentioned earlier, patients being late or things like that happen. Are those kinds of things preventable? What would be considered something you can foresee?

Dr. Napoleon Player: So, we do a lot in our Kirkland Clinic, a lot of preparation for inpatients and outpatients. And so, working with the surgeons and understanding first off what is the posting, what is the case, what are the required implants and, you know, what are the required instrumentation, because that's a very complex process.

And so, that communication is key. That is one thing that we do. We do several huddles and planning for our surgical procedures with our surgeons, anesthesiologists, and all of our collaborative partners to keep our patients flowing through. And so, poor communication, poor scheduling are things that are absolutely preventable.

And when we look at things like implants, those are vendors that are outside of our organization and partnering with them is very key to that. And so, to make our surgeons successful, we have to continue to prevent those in many different ways. And you start on time, end on time is the thing that I always say. And so, trying to get our first case starts as accurate and get them out the gate so that our following cases run on time.

Melanie Cole, MS: Yeah, that's so interesting, and it does require all that coordination. Now, how do these kinds of efficiency and delays impact patients and, Dr. Player, clinicians and the organization's overall performance?

Dr. Napoleon Player: Yes. And when we look at that, we have to look at that from a full holistic approach. We look at it from our patients. Of course, if you were fasting all night or just that anxiety, you're trying to coordinate your ride home, that's a requirement, that it gets a little difficult. And then, care post-operatively when you get home, you got to have those resources there, and that's important to our patients. And so, the delays really push their day back. It really pushes their whole plan.

So, everybody comes to surgery with a plan, and that really affects our patients, and we really watch that. We really try to lean into making sure we reduce delays and try to plan for those. For our clinicians, there are a lot of different areas that we can look at that from the coordinating of care, with our other collaborative partners in radiology, blood bank. They're on the ready. And when we start delaying, they have a schedule that they have to keep to. So, we have to partner there outside of just perioperative services. And the floor, the floor nurses and ICU nurses, they're all waiting for that. The ER usually has patients that are trying to get access to the operating room. So, one delay throws the whole day off. And so, we really try to partner with our clinicians as well.

Overall organization performance, when we look at just the overall workflow, the operating room is a valuable asset that is very costly. And we look at it by the minute. And every minute wasted, you can add up a lot of money and a lot of waste really quick. So, we really try to make sure that we look at that from an overall perspective for our overall hospital because pushing cases later incurs costs to our staff going into overtime.

Again, just overall for the patient, that anxiety creeps up every hour that you don't know what's going on. Every minute, it seems like four days for them. So, we always try to do that, and just make sure that we can get our patients discharged as well. So when you have those late cases coming out, then, you know, that's a much later discharge out of our facility or discharge to the floor. So, many different avenues in which we look at delays and understand the impact of that as operating room executives.

Melanie Cole, MS: Dr. Player, this is such an interesting topic that really applies all across the healthcare institution spectrum. And you've touched on a few of the strategies. But if you were to think what strategies or best practices that you've seen that successfully reduce those delays and improve efficiency. And as I said, you've mentioned a few, if you could expand on that, because it's really about that coordination of care.

Dr. Napoleon Player: Yeah. We really have to look at our preparation into the operating room and just partnering with everyone, the nurses, the anesthesiologists, the doctors, the clinics, just to get our patients coordinated and prepped for the operating room. Identify those barriers. We really look at our delays here and try to figure out ways in which we have a culture of, yes, i'm blessed to work with some amazing officers here at UAB. And they have a huge perioperative background, and they really hold us to a high standard of a culture of yes to help us facilitate communication across departments.

Some of the things that our operational leaders can do is honestly looking at transparency in the data through dashboards. We partner very closely with our hospital overall, the flow and making sure that things are flowing well and that we prepare from all aspects, and remove those operational barriers and make sure that everybody is aligned. We often hear in healthcare, it's a kind of an area that is very sensitive and it's staffing, and just making sure that everybody has staffing.

And it's not just our clinicians. We have patients. We have to make sure that they are fed, the rooms are cleaned. And so, partnering with all levels inside of the hospital to make sure that staffing is appropriate just fosters a culture of collaboration, accountability, and continuous improvement.

Melanie Cole, MS: Dr. Player, I really appreciate you joining us today and sharing your incredible expertise on this topic. As we wrap up, how can physicians, nurses, operational leaders such as yourself work together more efficiently to improve that OR throughtput? How does this all come together? And for other institutions really looking to make this more efficient and more streamlined, what advice do you have for them?

Dr. Napoleon Player: You know, at UAB Medicine, I think improving overall throughput, it's not about working harder, it's about working smarter together. When our surgeons, anesthesia professionals, nurses, and our sterile processing, patient transport, environmental services, operational leaders all function as one, as a coordinated team, it just makes our patients receive safer, more timely and experienced care in a very efficient environment.

I think that is one of the key things that I have, and just every minute in the operating room matters. Focusing on communication, preparation, standardization, and teamwork that reduces preventable delays and improve our inpatient outcomes.

And so, just having that care model of a culture of, yes, those are the ways that we partner with our care partners and make things better here at UAB.

Melanie Cole, MS: Thank you so much, Dr. Player, for joining us today. And for more information, please visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. I'm Melanie Cole.