VA Taking Significant Steps To Improve Surgical Care

By Jeff Robbins, LiveData, Inc.

The goal of the U.S. Department of Veterans Affairs (VA) is to improve access to timely, high-quality health care for Veterans. To achieve this goal, the Veterans Health Administration (VHA) has established initiatives to increase access to care, improve surgical safety and quality, and improve operating room efficiency.

These initiatives include measuring and tracking key performance indicators such as same-day surgery cancellations, first case on-time starts, block utilization, 30-day readmissions, and surgical safety compliance. While implementing tracking at the national scale can be daunting, the VHA has been on the leading edge of healthcare delivery in several areas, including the development and use of health information technology, and was ready to meet this challenge.

By leveraging the right off-the-shelf perioperative system of engagement (SoE) solution, the VA has been able to effectively meet its goals in multiple regions throughout the U.S.  This solution visually integrates patient information and perioperative case workflow to coordinate and manage the patient’s journey through surgery. Outcomes documented in a number of case studies highlight how VA facilities using this solution have been able to meet these goals.

For example, the VA San Diego Healthcare System has been using a SoE solution for more than a year in all eight operating rooms of its surgical suite. By collecting real-time operational data, the solution enables clinical teams and Operating Room (OR) managers to track and measure perioperative performance. The captured data is transformed into actionable quality, compliance, and efficiency intelligence.

By automating its perioperative workflow, the facility has been able to improve its operational efficiency and clinical quality. The facility reduced cancellation rates by 3.5 percent in the first 6 months, while simultaneously increasing first-case on-time starts by 10 percent. Facility administrators have also received positive feedback from clinical teams, who note how real-time visual information has improved communication about patients and safety during surgery.

In another example, a facility with 14 operating rooms uses this solution to visually coordinate the scheduling process through the patient's surgical consultation to the finalized surgical date, along with necessary patient preparation, tests, and assessments. Schedulers and OR managers can now review patient progress to ensure that patients arrive ready for their day of surgery. As a result, this facility reduced same-day surgery cancellation rates from 16.5 percent to 14 percent in one year.  Because the solution enables the surgical team to confirm that the necessary prerequisites for surgery have been completed, the facility was able to improve first-case on-time starts from 54 percent to 73 percent over a two-year period.

A VA facility in Florida, which serves a population of nearly 150,000 Veterans, implemented the solution and was able to add 1.8 additional cases per day by improving first-case on time starts from 47 percent to 82 percent, and block utilization from 70 percent to 79.5 percent. In terms of patient safety, this facility’s completion of the surgical safety checklist hit a 97 percent average and annual compliance over four years has never dropped below 96 percent.

Finally, the VA Southern Nevada Healthcare System used the solution to leverage an interactive version of the World Health Organization (WHO) surgical safety checklist, resulting in checklist compliance rates of over 94 percent throughout the facility. In addition, cancellations decreased from 101 per month to 51 per month, in only three months’ time.  This dramatic improvement was attributed to the visibility into underlying cancellation reasons provided by the solution’s analytic reports.

All of these VA facilities were able to increase access to surgery and improve clinical efficiency, as well as enhance surgical team communication in real-time with visually-rich displays of case workflows. Significantly, these improvements led to an increase in on-time starts, allowing more surgeries to take place each day and OR schedules to be more accurately planned.

Thanks to these efforts, the VA is taking major steps to improve access to timely care, while also streamlining OR workflows and boosting overall patient safety.  Ultimately, this improves the quality of care and helps the VA to advance its mission of providing exceptional care for Veterans.

About The Author

Jeff Robbins is the visionary founder of LiveData. Under Jeff’s leadership, LiveData has become a cutting-edge software provider, winning US Army SBIR awards, providing data integration for the MGH OR of the Future, and developing LiveData PeriOp Manager, a unique real-time System of Engagement for surgical utilization management. For more information about LiveData, click here.