Routine Post-Procedure Recovery (RPPR) patients at Massachusetts General Hospital

Abstract

This project offers improved strategies for managing the flow of surgical patients who are categorized as Routine Post-Procedure Recovery (RPPR) in Massachusetts General Hospital (MGH). Strategies were developed by analyzing the trade-offs in resource utilization of alternative recovery pathways. The unstandardized way in which the RPPR category is currently used creates a suboptimal utilization of hospital resources. RPPR is a booking category assigned to patients who are anticipated to be discharged within 24 hours of surgery completion. It is an internal booking category at MGH created to indicate Outpatients (as categorized by payers) whose recovery may mandate more than a few hours of hospital stay. The operational challenges incorporated in this patient population include: (i) vague definition of the category which leads to inaccurate classifications (booking category) of patients; (ii) high variability in booking practices among surgeons; (iii) high variability in patient length of stay; (iv) no established best-practice for recovery location or pathway. Problem definition and main areas for improvement were identified through data collection from hospital resources. Namely, clinician shadowing and interviews with administrative staff as well as statistical data analysis - utilizing the hospital's extensive digital databases. A key component to the recommendation development process was the grouping of surgical procedures with similar recovery pathways. This was essential to the analysis which focused on key metrics of those groups, such as patient length-of-stay, overnight stay, recovery pathways, and more. The goal of this study was optimizing the utilization of hospital resources for RPPR patients and developing actionable recommendations that would be implemented immediately. Our strategic solution approach focused on the development of a framework for establishing best practices for managing RPPR patients in increasing levels of detail. Best practices were determined for each procedure group, then for specific surgeon in each group and down to the specific patient. Each group of surgeons and procedures were provided with specific set of recommendations including booking category, recovery location and surgery time during the day. Through meetings with the surgeons and heads of different surgical departments, the project recommendations are being implemented in the hospital. Successful implementation will lead to improved operational efficiency in MGH, and will eventually benefit patients.