Healthcare organizations vary significantly in the number of expensive procedure rooms and equipment units that they use to accommodate similar numbers of annual procedures. This is why it is important to look at the current capacity prior to deciding to expand the number of procedure rooms and related support space, particularly those clinical services that use expensive equipment and uniquely-designed procedure rooms.
KEY QUESTIONS
Prior to committing significant dollars to expand or upgrade existing clinical services, key questions to ask include the following:
- Is the current equipment state-of-the-art? Would newer, upgraded equipment improve throughput and thus eliminate the need for additional procedure rooms? Can the current procedure rooms accommodate new, upgraded equipment considering room size and dimensions, ceiling height, floor loading capacity, and power and telecommunications requirements?
- Could the daily and weekly hours of operation be extended to allow more procedures to be performed per week with the existing or upgraded equipment, such as staffing the department during evenings or weekend hours?
- Even if the current number of procedure rooms is sufficient, is there adequate support space to allow the department to function efficiently and meet customer service needs, including staff work areas; supply storage; and patient waiting, reception, prep, and recovery space?
- Would relocating the department to an alternate location facilitate the sharing of staff, enhance customer convenience, or allow procedure rooms or support space to be shared with another department or service?
- Would a newly configured or relocated department reduce staffing costs, increase utilization and corresponding revenue, or provide other quantitative benefits that would balance the initial capital cost of renovation or construction?
DETERMINING CAPACITY
A capacity analysis for clinical services involves identification of the current workload volumes and major treatment spaces and then applying industry benchmarks and rules-of-thumb. The annual capacity can also be built up by first identifying the number of procedures that can optimally be scheduled in an hour, the number of hours per day that the procedure rooms will be scheduled, and then assuming 50 weeks per year of operation (allowing for about 10 holidays).
Some examples of factors that influence procedure room turnaround time include:
- Technology. With a traditional single-slice computed tomography scanner, patients were scheduled every 30 minutes such that each procedure room could accommodate 16 patient studies or procedures per day based on an eight-hour day. The newer scanners can acquire multiple images per second resulting in an average procedure time of less than ten minutes. This efficiency allows four patients to be scheduled per hour or twice the number as with the older unit.
- Patient mix and scheduling patterns. Physician offices and clinics will have varying utilization of their exam rooms depending on the type of patients being seen (e.g., dermatology, general surgery, oncology, pediatrics), teaching obligations, and scheduling patterns such as evening and weekend sessions.
- Responsiveness of support services. The time required to prepare a surgical operating room (OR) for the next case (OR turnover time) has a significant impact on the daily number of cases that can be accommodated in a single operating room.
- Responsiveness of other hospital departments. The turnaround of emergency department (ED) exam and treatment cubicles is greatly influenced by the responsiveness of the central laboratory and imaging departments if point-of-care services are not available; a shortage of inpatient beds can cause patients, who need to be admitted, to back up in the ED. The responsiveness of consulting physicians also impacts patient throughput.
CONCLUSION
It should be noted that even with adequate facility capacity, many healthcare organizations are limited in their weekly hours of operation due to the availability of physician, technical, and support staff (e.g., scheduling difficulties, recruiting in a tight job market, and regulatory or union issues with cross-training staff).
This article is an update of a previous post.