Follow Us

Follow @SheridanHC

Job Seeker

Putting the right people in the right places.
View Jobs

Sign up to receive regular updates on our progress in this ongoing effort as well as the latest events, happenings, webinars and white papers.
Sign Up

18 August 2014

JAMA Report Recommends OR Briefings to Reduce Errors

The operating room has been called the “revenue engine” of the hospital – at some facilities, OR services can contribute 60 to 70% of hospital revenues. However, according to the Journal of Patient Safety, 400,000+ people each year die from preventable medical errors - many of them in the OR. Last month, the Journal of the American Medical Association (JAMA) released a recommendation on ways to improve the safety and quality of care in an operating room: institute a standard briefing and debriefing process. An effective briefing can be performed in less than 2 minutes and can ultimately reduce delays by more than 80%, leading to hospital cost savings.

In a previous blog post, we discussed some of the obstacles hospital administrators may face when trying to institute hospital process improvements: 

  • Resistance to changefrom physicians and OR staff
  • Concerns about the added time
  • Hierarchy of a typical operating room.

Strategies to address these obstacles can be found here, but JAMA’s report is clear on the benefits of perioperative briefings:

  • Increased team communication
  • Fewer disruptions to surgical workflow
  • Improved overall perceptions about the safety climate in the OR

To conduct an effective briefing, follow these steps:

  1. Have team members introduce themselves by name and role
  2. Take a “time out” to focus on the case at hand without distractions
  3. Ask the anesthesiologist, surgeon, and nursing staff to provide a formal review.

A briefing process is also one of the key aspects of crew resource management (CRM), a strategy used by many hospitals to prevent OR errors. For more information on CRM, check out this blog post or download our paper on crew resource management, titled “Reducing Human Error in the Operating Room.”

13 August 2014

To Embrace Value-Based Care, Look For Economies of Scale

Value-based care was a hot topic at the recent American Hospital Association Forum, and continues to be a subject on hospital executives’ minds. While all hospitals are expected to eventually transition away from the fee-for-service (FFS) model, many are still straddling the line. According to a study conducted by the Office of Civil Rights, the majority of payors and hospitals are still using a dual system of value-based and FFS reimbursements, but 60% are on track with the transition to value-based models. These groups predict that FFS reimbursements will decline more than 20% over the next five years.

Since costs and quality of care factor heavily into value-based purchasing, one strategy for hospital system leaders to help smooth the transition is to increase economies of scale where possible. Executives can spread technology or hospital management costs across multiple hospitals in a system to help bring down individual costs. In a report aimed at helping hospitals master value-based payment, Lisa Goldstein, managing director for Moody’s Investors Service, said “The contemporary thinking is that under reform, the bigger you are, the more you can spread the costs of your infrastructure over the enterprise's footprint…Long term, you can leverage a less-expensive healthcare system to payors, exchanges, employers and all purchasers of healthcare.”

Standardized procedures and common success metrics can go a long way towards maximum efficiency and decreased costs – and these savings are magnified when applied across multiple hospitals in a system. Learn more about our approach to managing hospital operations, and talk to us about using our health care management services across different hospitals in your system.

5 August 2014

What Will the Two-Midnight Rule Cost Hospitals?

One year ago, the Centers for Medicare and Medicaid Services (CMS) adopted the “two midnight” rule, which called for doctors to admit a hospital patient as an inpatient case only if he or she required at least two nights of observation. The law was designed to reduce unnecessary hospital stays, but groups like the American Hospital Association (AHA) immediately pushed back – they argued that this “wholly arbitrary requirement” was a “black-line rule” that takes clinical decisions out of the doctor’s hands.

How does this policy affect a hospital’s bottom line? A report from Moody Investor Services estimates that the two-midnight rule could end up reducing average reimbursement per case by $3,000 to $4,000, since CMS typically reimburses hospitals at lower rates for outpatient cases. This will also impact the volume of patients, which may mean decreased hospital efficiency and overall earnings. Tenet Healthcare, a major hospital system, anticipates losing up to $25 million on both volume and earnings as a result of this rule.

Often times, hospital administrators look to emergency department (ED) doctors to guide whether a patient should be admitted or not. In an interview with Fierce Healthcare, Catherine Polera, Chief Clinical Officer of Emergency Medicine, discussed what this law could mean to these teams. She predicts that some ED patients may sign themselves out against medical advice when they learn they could be responsible for a portion of their hospital bills. This contributes to higher Left Before Being Seen scores for hospitals and increased costs, as these patients will often require additional care when they return to the ED even sicker than before.

In April, the AHA banded together with other associations and hospital groups to file two lawsuits against the U.S. Department of Health and Human Services to challenge the rule. As the U.S. population ages and more individuals are eligible for Medicare, this remains an issue of concern for hospital administrators. The actual implementation of the law has been delayed to 2015 – for now.

29 July 2014

Use Crew Resource Management to Prevent Errors in the Operating Room

In a previous post, we discussed the cost of human error in the OR and the benefits of using Crew Resource Management (CRM) to improve communications. Despite these benefits, physicians can still be reluctant to embrace change and participate in process improvements. In these situations, buy-in from hospital executives and physician department chairs play a key role in embracing and introducing CRM to the operating room.

Address Concerns with Facts
An initial concern of surgeons and anesthesiologists is that the briefing phase will add time in the operating room at the end of each surgery. In a study of more than 37,000 cases in a large medical center, it was found that debriefing took an average of 2.5 minutes to complete, yet this time was recouped in the areas of surgery preparation and performance. Some hospitals found that debriefing actually makes surgeries more efficient and takes less time overall because less time is spent leaving the sterile field to acquire additional instruments or to assemble equipment.

Break Down Traditional Roles
Achieving egalitarianism in the operating suite is another challenge for hospitals. Typical operating room settings have an uneven power structure in which the surgeon is in charge and the medical staff is there to support the surgeon’s role. However, this approach is one-sided and goes against CRM principles. Hospital management’s commitment to the quick resolution of problems and sticking to the processes standardized by CRM will break down these traditional roles and mindsets that are detrimental to patient health and safety.

Results
When an OR department embraces CRM, the results include improvements to quality of patient care and safety. Hospitals across the nation using CRM have reported: 

  • Reduction in untoward outcomes and sentinel events 
  • Discovery of errors that previously would have gone unrecognized 
  • Prevention of wrong-side surgeries 
  • Prevention of potential medication errors Reduction of serious safety events 
  • Reduction in the three-year Mortality Index 

Our leadership brief on reducing human error in the operating room outlines the benefits of CRM and includes the steps for successfully implementing it. Download the article here.

23 July 2014

The Cost of Human Error in the Operating Room

Every year, an estimated 15 million Americans suffer medical harm in hospitals. These errors can be dangerous to patients and also expensive; they cost the health care system $17.1 billion annually.

The most common cause is miscommunication between healthcare workers. Communication errors can be especially dangerous in the operating room; because of this, hospitals have a vested interest in improving communications among OR staff. However, they often turn to admonitions and behavioral sanctions, which are seldom effective.

Recently, some hospitals have looked to other high-risk industries for answers and best practices. Fields as different as aviation, nuclear power, and the military use Crew Resource Management (CRM) to improve communication and ultimately reduce errors and decrease costs.

CRM empowers each OR team member to identify and communicate potential patient harm and contribute equally to the solution. For example, an OR staff member at any level can voice his or her concern by calling a “time out” to immediately pause the surgery in order to discuss the concern or safety issue.

The elements of CRM include: 

  • Pre-procedure briefings 
  • Recognition and verbalization of safety-related red flags
  • Mandatory “time outs”
  • Collaborative creation of standards, procedures, and protocols
  • Empowerment of all team members
  • Immediate post-operative debriefs
  • Culture of continuous improvement

Our next post will examine the roadblocks to CRM and the benefits hospitals have experienced when implementing it. To learn more about reducing human error in the operating room, read our leadership brief.

16 July 2014

When Evaluating Your Hospital’s Partner, Ask These 4 Questions

For hospital leadership looking to partner with an outsourced anesthesia services group, our best advice is to make sure your goals are aligned with those of your potential partner. In the video below, the CEO and CMO of Jersey City Medical Center discuss four questions a hospital leader can ask to evaluate a potential partner:

  • What is my hospital’s mission? How will a partner help me achieve that mission?
  • Are the lines of communication open in both directions between my hospital’s leadership and the partner’s leadership?
  • Is my partner engaged with what I am trying to accomplish at my hospital?
  • Does my partner have a culture that is focused on safety, hospital efficiency, and quality care?

See their responses in this video:

Watch and read more testimonials from our hospital partners.

8 July 2014

Challenges of Leveraging Kaizen at a Hospital

Lean process methodologies were originally developed for manufacturing and industrial settings, so they may seem out of place in a hospital. But the principles behind lean processes are even more important in a clinical setting, where increased hospital efficiency can help manage risks and ultimately lead to better quality of patient care. Kaizen, which means “rapid improvement for the best” in Japanese, is one of these lean process methodologies. In an article for Beckers, Neonatology Chief Dr. Luiz Grajwer share his advice on how hospitals can use a Kaizen event and facilitator to address physicians’ hesitations.

“[Physicians] have our own language and our own way of communicating with each other, but we can be resistant to new terminology, which is why Kaizen presents a very real challenge to leverage in a hospital setting. Kaizen is rooted in the business world, which has its own lexicon and can seem like learning a different language.

However, once Kaizen is explained to physicians in terms they understand, these leaders can begin to see multiple solutions to the challenge at hand. Physicians who are familiar with the Kaizen event's goals can function as a bridge for all individuals involved in the process. In this way, he or she can create the environment that allows for visualization and analysis of the issues and support a culture that permits open communication, respect for all team members with the common goal of improvement, and value for all. This is why a Kaizen facilitator is another necessary member of any event. Interdepartmental communication is often a sticking point at many hospitals, but Kaizen integrates different sectors of the hospital, breaking down communication silos and setting aside traditional barriers that can prevent teams from finding ways to more effectively assist patients.”

For more information, read the full Becker’s article or contact us.

3 July 2014

Legendary Leaders Meet at HFMA

Strong leaders make a huge difference to a hospital or ASC because they provide clinical team members a set of goals and the tools to achieve them. Who better to make that point than two of America’s greatest leaders – George Washington and Abraham Lincoln?

From June 22 – 24, we attended the Healthcare Financial Management Association (HFMA) National Institute conference in Las Vegas to discuss the importance of effective clinical leadership with hospital financial executives. At our exhibit, we shared leadership trivia and Sheridan insights with attendees. Washington and Lincoln hosted our visitors, posed for photos and discussed leadership.

At the conference, attendees were interested to learn about Sheridan’s outsourced health services, including anesthesia department management, and how we ultimately improve our clients’ bottom lines by helping to reduce costs, improve hospital efficiency, and increase quality of patient care.

Did you get your photo taken with Abe and George? Flip through our event photos and find yourself!

23 June 2014

Kaizen in the Emergency Department: St. Mary’s Medical Center

What happens when ED patients experience long wait times to see a doctor and have to spend hours in the hospital? St. Mary’s Medical Center faced this issue in 2013. The hospital brought us in to help improve its emergency department’s workflow as well as communication between different ED staff members.

Over a 2-day Kaizen event, we worked with a 20-person team to increase patient satisfaction and reducescores at St. Mary’s. Our Kaizen team was led by a physician and included two RNs, members of the IT department and individuals from LAB and C/T. We identified and removed the critical constraints that were increasing length of stay for patients, and installed effective process tracking as an ongoing “plan-do-check-adjust” cycle, a 4-step management tool to monitor process improvement.

Today, this hospital is one of our highest-performing clients.

18 June 2014

Customized Pre-Admission Testing Helps Hospitals Allocate Resources

Each patient who comes through a surgery center is unique, with his or her own medical history and set of needs. But for a long time, hospitals used the same standardized pre-admission testing process, subjecting patients to unnecessary tests and resulting in higher costs. To combat this issue and increase hospital cost savings and efficiency for our clients, we researched best practices and developed ClearPATh, a proprietary pre-admission testing program that considers multiple factors and streamlines the testing process to reduce cancellations.

A Patient-Centric Approach
ClearPATh considers each patient’s medical history and takes a patient-centric approach to preadmission testing. The program includes guidelines and algorithms based on high-, medium- and low-risk procedures, as well as patients’ comorbidities. The same surgeon performing the same surgery on two different patients may order different tests based on the patients themselves.

For example, two patients may be having knee surgery. One, an otherwise healthy male in his mid-50s who exercises routinely, with no medical problems, no medications and no comorbidities who is having the surgery due to an athletic injury would most likely undergo basic blood work as a low-risk patient. The other patient, also in his mid-50s, with diabetes, high blood pressure, obesity, sleep apnea, multiple medications or a cardiac stent, would be considered high risk and need a cardiac evaluation, EKG, more blood work and blood glucose testing.

Testing in Advance
ClearPATh also stresses pre-admission testing before the day of the procedure. This allows the surgeon and anesthesiologist to review and coordinate prior to the procedure so that resources can be allocated properly. The patient and family will know whether or not to take time off work for that day. This reduces the incidence of same-day cancellations and increases satisfaction and ensures that the OR is booked accordingly.

We are in the process of bringing ClearPATh to all our anesthesiology programs.