Madison Belissary, perioperative operations director at MUSC Health
Photo: Madison Belissary
Surgical demand at MUSC Health, a large health system serving South Carolina, had been growing significantly over the past few years, and its main OR location was running at consistently high utilization.
That left the health system with very little flexibility to absorb delays or creeping inefficiencies.
THE CHALLENGE
At the same time, visibility into performance was limited to manually entered timestamps in the EHR, which made it difficult to understand where time was actually being lost. Those data points were often questioned, especially by surgeons, who saw them as prone to human error and hard to trust.
Without a shared, trusted understanding of performance, discussions about how to solve any efficiency problem were shaped by assumptions instead of evidence, said Madison Belissary, perioperative operations director at MUSC Health.
"At that point, it was clear we needed a better handle on how our OR time was really being used so we could make better use of our capacity and make decisions our physicians and staff could trust," she added.
PROPOSAL
MUSC Health implemented vendor Apella's technology to get an objective, real-time view of what was actually happening inside its operating rooms, Belissary explained.
"The goal was to move beyond the manual EHR data we had been relying on and instead have a more complete and accurate picture of our operations," she continued. "We could then use this ground-truth data to make better informed decisions around capacity.
"The platform uses ambient AI technology integrated with our EHR data to automatically detect OR events and capture a granular timeline of what happened during each surgery and turnover," she added. "Instead of relying on staff to document timestamps, it would passively capture what's happening in each room, instantly make those updates visible to our teams and also develop predictions on future cases."
For staff, that was key, because they were trying to make better use of the capacity they already had.
"Before committing, our leadership team was very deliberate about how we approached any new technology investment," Belissary noted. "We needed confidence it would actually help us operationally, and that it wasn't just about trying something new just to try it.
"That meant it had to be implemented without disrupting OR operations, it had to earn the trust of our physicians and staff, and we needed to be able to see value quickly," she continued. "If it couldn't meet those expectations, it wasn't something we were willing to move forward with."
MEETING THE CHALLENGE
The health system implemented the platform through a structured rollout focused first on the people closest to daily OR operations.
Since Apella was integrated with the EHR and fit into existing workflows, staff were able to complete implementation outside of peak hours and bring it online without disrupting throughput or adding burden to staff.
"It immediately gave our teams a clear view of what was originally scheduled compared to what was actually happening in the rooms," Belissary said. "This created a real-time understanding across the whole team that we hadn't had before, and adoption was largely organic because the tools fit into our workflow.
"Charge nurses used the live view tool to monitor room status and manage the schedule in real time," she continued. "Coordinators used its predictive updates to anticipate issues before they happened and adjust staffing proactively. We also made a point to involve surgeons early in the rollout to build trust."
A governance committee was established that had surgeon champions shaping how the technology would be used, what metrics were important to staff and implementing guardrails.
"Within weeks, we saw 100% weekday adoption among charge nurses, and the platform's reach expanded quickly from there as pre-op, post-op and anesthesia teams requested access and effectively doubled the user base," Belissary reported.
"Beyond day-to-day management, the platform was used by perioperative leadership to identify where we could improve, specifically by identifying the key drivers of inefficiency and giving us clear direction – and the tools to act on them," she added.
RESULTS
One of the most immediate results MUSC Health realized was a dramatic improvement in data quality. Apella's timestamps were six times more accurate than manual EHR entry, with event updates delivered in less than a minute – compared to delays of up to 45 minutes with the EHR – all without requiring any manual input, Belissary said.
"This eliminated much of the skepticism we had previously faced around data accuracy and gave us a shared source of truth across teams," she said. "Additionally, within the first 60 days of implementation, the platform gave us clear insight into where exactly time was being lost, which disproved some of our long-held assumptions and gave us the tools to address each of the gaps.
"For example, we believed extended cleaning times were the primary cause of long turnovers," she continued. "But with the platform, we were able to segment each turnover duration into phases – cleaning, setup and idle time between – and the data gave us a better view of where time was being spent."
It revealed that delays were actually driven by idle time between the end of cleaning and the start of setup, often 10 to 15 minutes in some service lines, pointing to a coordination gap.
"To address this, teams now use the platform's real-time schedule views, turnover predictions and delay alerts to identify at-risk turnovers in advance," Belissary noted.
"We saw a similar pattern with scheduling and unused capacity," she said. "Roughly 28% of our cases were underscheduled by more than 30 minutes, which led to delays and staffing strain. At the same time, about 20% of cases were overscheduled by the same margin, leaving valuable OR time unused."
The platform helped staff uncover what they had not been able to see before – they had recurring pockets of unused time, or "white space," that could have been used to add cases but were consistently going unfilled.
"We're now able to identify upcoming cases that are highly over- or underscheduled so we can make necessary adjustments ahead of time," Belissary concluded.
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.
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