1. 1 Canadian Institute for Health Information

2. Exploring Occupancy Through Administrative Data: A Test Case Using Operating Rooms Emerging Issues 2015 2

3. Objectives for Today Outline methodology for estimating occupancy of constrained resources Preview pan-Canadian data using operating rooms (ORs) as case study for the methodology 3

4. Measuring Occupancy Methodology using administrative data to estimate use of physical resources Requires understanding 3 concepts 1.Number of resources available for use 2.Hours of active use 3.Estimate of occupancy of resources Demonstrate the methodology using data on ORs 4

5. Why Test Methodology on the OR Setting? 5 Typical reporting for OR measures % staff time = total time patients were in OR total time staff available % blocked/scheduled time = total time patients were in OR total hours reserved for surgeon(s) Addresses this scenario: “What is OR utilization, given existing resources? A look at how the OR functions when staff is working or intended to be working.” ORs account for a significant portion of hospital costs and there is little comparable information at the regional and provincial levels Information is important to regional and provincial planners for managing access to care, emergency preparedness

6. OR-Specific Questions What is the number of ORs in Canada? (available resources for use) What is OR activity during standard daytime shifts? (hours of active use) What is the estimated OR occupancy rate in Canada? 6

7. Data Sources and Data Quality Ambulatory (NACRS and DAD) and inpatient (DAD) surgical information is reported to CIHI –Captures location of surgery, time/date patient entered and left OR, nature of the procedure performed and other demographic information Includes all procedures in a main OR Excludes –Procedures performed in endoscopy rooms, cardiac catheter rooms, obstetric rooms and other OR resources, such as pre- and post-operative rooms –Procedures without a valid start or end time –Facilities with <75% of procedures having valid date/time or location Excludes all of Alberta, Quebec and Nova Scotia In other provinces, 41 (12%) facilities were not included 7

8. What Is the Number of ORs in Canada? 8 ORs Concurrently in Use 15-minute snapshots over a standard day (8 a.m. to 4 p.m., Monday–Friday, excluding statutory holidays) Core assumption: at some point during the year, all available ORs are simultaneously in use

9. What Is the Number of ORs in Canada? 9 Good to know Dismissed extreme values (top 1%) to protect against atypical or data entry errors Last week of the fiscal year is excluded for wash period Non-functional or “mothballed” ORs (not used during the year) are excluded

10. Typical OR Working Hours 10 Non-Urban FacilitiesUrban Facilities Non-UrbanUrban Average hours in typical day7.38.6 OR start and end times8:07 a.m.–3:21 p.m.8:00 a.m.–4:28 p.m.

11. What Is the Number of ORs in Canada? 11 Total of 1,243 ORs across 242 facilities with 1 to 33 ORs per facility

12. What Is the Number of ORs in Canada? 12 Benefits Quick, low-cost and repeatable counting, compared with surveys Consistent approach with common definitions across regions for operational resources (versus physical) Limitations Some ORs may be reserved for specific procedures, such as traumas; these can’t be differentiated Intentional planned partial closures can’t be identified as such Validation B.C. (provincial) and Ontario (selected sites)—administrative data matched or was 1 to 2 ORs lower (swing) Proposed standard work day (usual start and end times)— consistent with literature and seen as reasonable by those in the field

13. What Is OR Activity During Standard Daytime Shifts? 13 OR activity involves 2 components: 1.The time patient is in the room (from administrative data) 2.Turnaround time (added manually) We used 15 minutes for ambulatory care and 30 minutes for inpatient Good to know In the literature, OR turnaround time varies greatly (18 to 45 minutes) Ontario uses a calculated average per type of surgery Estimates are sensitive to turnaround time adjustments Turnaround TimeOccupancy Rate Less5 and 20 min62% Project15 and 30 min70% More25 and 40 min78%

14. What Is OR Activity During Standard Daytime Shifts? 14 Benefits Sets a standard/comparable turnaround time (less subject to outliers) Limitations Becomes more of a limitation as practice varies from standard or if there are more select surgeries where turnaround is longer (i.e., bilateral hip versus open resection for colon cancer) Validation While proposed timing of 15 and 30 minutes was viewed as reasonable from those in the field, there was limited data on actual practice

15. What Is the Estimated OR Occupancy Rate for Canada? 15 Occupancy rate during a standard daytime shift was defined for Canada (and facilities) as follows: Good to know Rate was stable from 2011–2012 to 2013–2014 OR space is not the bottleneck for increased surgical volume

16. What Is the Estimated OR Occupancy Rate for Canada? 16 Facility-level OR occupancy rates ranged from 2% to 87% 12% of facilities had occupancy rates >80% 35% of facilities had occupancy rates <50% Less variation within urban areas

17. What Is the Estimated OR Occupancy Rate for Canada? 17 Potential reasons for lower OR occupancy: Patient need—lower in sparsely populated regions compared with urban areas Surgeon, anesthetist or nursing availability Lack of funding available Partial closures Specialized rooms (i.e., trauma ORs or Caesarean section rooms)

18. What Is the Estimated OR Occupancy Rate for Canada? 18 Benefits Can be used for “at-a-glance” calculations to assess/model potential throughput Limitations Lack of granularity on low occupancy rates (staffing, full and partial closures)

19. Questions 19 Contact: healthreports@cihi.cahealthreports@cihi.ca Access the full technical report on CIHI’s website.technical report

20. 20 Thank You