Breaking Barriers: How One Hospital Redefined Surgical Efficiency

On October 14, 2023, a remarkable pilot occurred at Humber River Health in Canada. A surgical team at a hospital challenged the status quo in a healthcare system often criticized for its inefficiencies and long wait times. They set out to deconstruct and rebuild how surgical care is delivered, specifically in the case of Anterior Hip Replacements (AHR). This groundbreaking effort defied conventional norms and provided a model for improving surgical efficiency, lowering costs, and, most importantly, enhancing patient care. Considering my extensive experience in surgical efficiency, I have taken this as an opportunity to amplify the efforts conducted in this pilot and note the critical factors behind this transformation and the potential for scalability and replication.

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A Remarkable Achievement

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Traditionally, a Canadian orthopedic surgeon would perform 3 to 4 AHR surgeries daily. However, on that Saturday, the team at Humber Hospital demonstrated that one Surgeon could complete 12 AHR surgeries between 8:00 am and 3:30 pm. The outcomes extended beyond the number of surgeries performed:

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• Room Turn-Around-Time (TAT): Patient out-to-patient-in time was consistently reduced to just 15 minutes, compared to 30-40 minutes.
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• The intra-operative duration was slashed by over 40%, achieved through improvements in various processes, such as set-up, tear-down, and surgical navigation technology.
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• Patients who bypassed the Post-Anesthesia Care Unit (PACU) were sent directly to day-surgery recovery before being discharged home.
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• Significant reductions in waste, including garbage and linen, were observed.

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This impressive achievement resulted from months of planning and collaboration among surgeons, anesthesiologists, hospital administrators, and industry experts. However, the question is whether this transformation is sustainable and reproducible for other surgeries and hospitals.

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Replicating Success

To understand the potential for replicating this achievement, we need to dissect the critical components that contributed to its success:

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• Economic and Social Urgency
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  The COVID-19 pandemic exacerbated wait times for hip andknee replacement surgeries. Patients often waited over a year, experiencingdeteriorating function and increasing pain. The Ontario government responded byfunding Saturday surgeries while adopting a Quality-Based Procedure (QBP)approach - pay per-case rather than global funding. This change incentivizedhealthcare providers to improve surgical throughput, leading to the success ofHumber Hospital.
  
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• Detailed Activity Analysis
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  Every activity in the surgical process was meticulously analyzed to determine the appropriate duration and resource requirements. This included a thorough examination of room turn-around time and a detailed breakdown of activities involving anesthesiologists, surgeons, and nurses during surgery. While labor-intensive, this approach ensured a meticulous plan to maximize efficiency.
  
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• Creating Ideal Pilot Conditions
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  The success at Humber Hospital was achieved under ideal conditions—a carefully planned pilot program. The surgeries were identical, and the team involved a single orthopedic surgeon. However, this level of control is rarely found in typical hospital settings, where multiple surgeons and services operate simultaneously.

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The Path to Scalability

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While the initial assessment might suggest that replicating this pilot's success is challenging, there is a strong case for prioritizing surgical efficiency across the healthcare system. Rising healthcare costs and the need for timely care make it imperative to develop scalable solutions. The critical question remains: can today's advanced computing power and AI capabilities facilitate the scaling of this initiative not only within Humber Hospital but also in other healthcare facilities with a similar focus?

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The transformation of surgical efficiency achieved at Humber Hospital represents a beacon of hope for a healthcare system that often grapples with inefficiencies. While the unique circumstances of the pilot may pose challenges to scalability, there is an apparent economic and social urgency to improve surgical throughput and lower costs. Today's technology offers promising tools for realizing this goal, which could ultimately enhance patient care, improve morale, and make healthcare more accessible. Achieving transformative changes in surgical efficiency is a critical frontier in saving our healthcare system, and the technology is ready to facilitate this journey.

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