On-Time OR®
Bending the cost/quality curve by finding efficiencies at the elective/emergency surgery interface
Is a web-based operations management tool for emergency surgery waitlist management
ON TIME ALL THE TIME
On-Time OR offers decision support to operating room management by ranking cases in a medically appropriate order
The On-Time emergency surgery platform creates a dynamic multi priority “scoreboard” that follows the timelines of every patient on the emergency surgery wait-list.
Cases are color coded according to their urgency level.
The dynamic wait list is available to registered users over the internet.
Surgeon users can login remotely to add, remove or modify cases.
On-Time keeps track of each patient’s personal timeline and this ensures that no one is ever left behind.
There is an integrated notification system to coordinate surgical teams.
An analytics page presents utilization and turnover data in real-time.
On-Time is scalable and can easily be adapted to work at any hospital.
smooth transition through all surgical stages
On-Time OR has an in progress list which records times on operations that are under way.
integrated Simultaneous Team Notification
A notification function uses two-way SMS texting to co-ordinate each surgical team.
Track multiple surgical timelines
On-Time OR organizes all emergency surgery cases into a single unified list by inter-collating multiple surgical timelines.
introduction
About emergency surgery in Canada.
Emergency surgery represents about 25% of total Canadian surgical output annually.
This amounted to 538,000 surgical cases across Canada in 2012.
Unlike elective surgery which is scheduled in advance, emergency surgery time is allocated according to priority.
Currently most Canadian operating room managers use static whiteboard or clipboard style systems to manage the caseload.
Static systems have many limitations, but most notably, they are non-digital
An Innovation in Emergency Surgery Scheduling
Designed by the end-user in response to necessity.
The new system design emphasizes three functionalities
✓ Dynamic multi-priority display.
✓ Two-way short message service (SMS) notification.
✓ Info graphic analytics in real time
Construction of the first system began in India in 2016.
When a third prototype proved to be successful, final construction was moved to AY Technologies in British Columbia in 2018.The On-Time system meets all necessary technical requirements under Canadian Federal and Provincial privacy law (FIPPA and PIPEDA).
The On-Time OR System is available for deployment anywhere in Canada.
The On-Time OR Scheduling system can be obtained under license in several other countries.
In a three-month prospective open-label comparative trial, we tested the On-Time system against a standard static system. Here are some results…
User acceptance surveys were collected from 70 users. The hospitals Patient Safety Learning System (PSLS) was monitored for any evidence of an impact on patient safety. The system proved to be safe and reliable. The data generated proved to be accurate and useful. Surgeon users “really liked” the new system.
Results from the clinical trial:
The new system is safe and reliable
✓ The electronic system was reliable experiencing no outages or shutdowns over 89 days
✓ Comprehensive surgical case data from 703 emergent, urgent and unscheduled surgeries was recorded digitally with over 14,000 data points
✓ PSLS records showed no impact on patient safety
✓ User acceptance was excellent for surgeon super users
Features Overview
The on-Time main screen waitlist is dynamic. Cases are colour-code according to their urgency level. Cases that go past their wait time target are counted up in red text as “Overdue”.
A DYNAMIC MULTI-PRIORITY WAIT LIST
Go Dynamic.
The On-Time system inter collates the multiple different timelines from all of the various surgeries that are on the list. After making the comparison the computer builds a medically appropriate representation of the emergency surgery waitlist. Cases are colour coded according to their urgency level and the waitlist is always in the proper order.
FLEXIBLE SETTINGS AND INDEX
A flexible settings page can be quickly re-configured to fit the location settings for any new hospital. Likewise, an adjustable directory allows the super administrator to add or remove users with ease.
A settings page can easily be modified to fit a different set of location settings. This allows the On-Time system to be quuickly reconfigured to work at any hospital in Canada. There is also a modifiable directory setting where users can be added or removed easily by the nurse operatign room manager.
When a case is called to the operating room all team members assigned to the case receive a simultaneous text. If a team member fails to respond to their text the desk will recieve a “non-responder alert”.
AN INTEGRATED SMS NOTIFICATION SYSTEM
An integrated notification system of two-way SMS texts coordinates the surgical team and a non-responder alert ensures that no one is left behind.
Some quotes about innovation
If you have always done it that way it’s probably wrong - Charles Kettering
If you want to start doing something new, you have to stop doing something old - Peter Drucker
When the winds of change blow some people build walls and others build windmills - Ancient Chinese Proverb
They always say time changes things, but you actually have to change them yourself - Andy Warhol
Process improvement innovation is about getting things to work more smoothly. This also has the effect of releasing resources for use in other important areas.
A word about process innovation
In A recent report from Mckinsey.
In a recent report from the business consultancy McKinsey and company considerable growth was noted in the healthcare market over the past decade for products of this kind. McKinsey is also projecting that growth trends for these types of IT solutions are likely to intensify (Reddy, et al, 2018). The McKinsey report states:
“Health management solutions are … likely to grow rapidly due to cost concerns. Data-enabled decision making in both clinical and business processes are expected to make bending the medical cost trend possible”. - Reddy et al
Many observers consider innovation to be a critical component of business productivity and competitive survival (Omachonu, V. K., and Einspruch, N. G. 2010). Most commonly, product innovation provides companies with a means to build incremental revenues (Johne, A., 1999). In the present context, On-Time OR® is offering a process innovation which is concerned with improving internal capabilities and safeguarding and improving quality (Johne, A., and Davies, R., 2000). In healthcare this will mean better outcomes for patients.
References:
Johne, A. (1999). Using market vision to steer innovation. Technovation, 19(4), 203-207.
Johne, A., & Davies, R. (2000). Innovation in medium‐sized insurance companies: how marketing adds value. International Journal of Bank Marketing.
McColl, E., Jacoby, A., Thomas, L., Soutter, J., Bamford, C., Steen, N., ... & Bond, J. (2001). Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Core Research.
Omachonu, V. K., & Einspruch, N. G. (2010). Innovation in healthcare delivery systems: a conceptual framework. The Innovation Journal: The Public Sector Innovation Journal, 15(1), 1-20.
Reddy, P., Onitskansky, E., Singhal, S., & Velamoor, S. (2018). Why the evolving healthcare services and technology market matters? McKinsey & Company, 12.