An HFMA Healthcare Financial Pulse Resource
Why would a business expand its physical space without a demonstrated need?
Well, if the business is a hospital, sometimes physician and staff preferences can look a lot like need, particularly if the hospital doesn't really know what it has and how it's being used. And so it's not unheard of to see hospitals adding operating rooms without realizing that their current surgical space has a 50 percent utilization rate.
Many people argue that staffing is workload-based, says Joyce Durham, RN, AIA, principal and director, facility planning practice, Healthcare Strategies & Solutions. "But many CFOs rightly point out that staff expands to fill space."
As a result, when an OR has eight rooms but there is only enough volume to necessitate six, hospitals may find themselves with surgeries running Monday to Friday from 8 a.m. to noon, and staff filling up the afternoon hours with restocking, cleaning, and organizing.
"Instead, you could market to other physicians to try and get more cases, or run the rooms just four days a week, or close or convert two of them," Durham says.
1. Know What You Have
One of the biggest challenges to effective utilization is that many organizations simply don't know how many of their beds are in operation-and beds are 40 percent of the space in a typical hospital. This is why just documenting the number of inpatient, outpatient, and short-stay beds you have and determining occupancy rates by unit can be a very helpful exercise, Durham says.
"Documenting usage will also tell you whether you have an excessive number of inpatient or outpatient units," she says, citing the example of one hospital with a 20-bed cardiovascular recovery center that realized the space wasn't being fully used since post-catheterization recovery time had shrunk from between six and eight hours to about two hours in recent years.
2. Think Additional Purpose
When faced with these kinds of low-occupancy situations, the next step is to determine whether the space could be put to some other use. "For example," says Durham, "surgical ICU is often separate from medical ICU, especially in community hospitals, but the census in surgical ICUs usually goes down over the weekends. Could you use some of those beds for ED observation?"
Durham notes that a lot of ED patients are admitted for a single day, perhaps to receive IV medication or to wait for a consult. "One hospital decided to keep all the one-day stays in a certain area of the ED, which opened beds for sicker patients who were often held in the hallway," she says.
3. Keep an Eye on the Usual Suspects
A common place to look to maximize space is outpatient recovery. Historically, there have been small pockets of recovery bays adjacent to procedure rooms all over the organization. Durham suggests consolidating those pockets into a single shared area for each floor or other appropriate grouping.
"One thing that's very helpful is to determine how long different kinds of patients need to recover. If inpatient beds are really tight, then it may make sense to extend hours in one of the outpatient areas-close at 10 p.m. instead of 5 p.m., or stay open all night if necessary. And then if the ED is overflowing, some of their patients could be shifted to this unit for observation."
It's very hard to get cost out of facilities. It costs about the same to use 50 percent or 80 percent of a space, so it's important to look at operational opportunities to maximize facility use.
"Do you have some facilities that you can exploit to expand programs? Clinic areas for after-hours care, procedure rooms for sedation cases done in the OR, and recovery bays for short-stay patients are all areas to consider," says Durham.
Who knows? If you keep an eye on occupancy and the many opportunities to make best use of facilities and allocation of beds, you may find you don't need that addition after all.
Publication Date: Monday, October 26, 2009