For over three years, Providence Health Care (PHC) has had integrated and coordinated methodologies to allocate surgical resources (OR time and surgical beds). OR Resource Allocation Methodology (RAM) is a data-driven, patient-focused methodology to allocate OR time based on surgical waitlist growth and wait-time performance. Vancouver Coastal Health (VCH) and PHC started developing this methodology in 2004; PHC pilot tested it in 2006 and fully implemented it in January 2007. The methodology has been refined several times and is now used every six months to develop a master OR schedule. RAM is now implemented at three of the four major surgical sites within VCH, and the fourth will come on board in the next few months. Surgical Bed Allocation Methodology (BAM) is a data-driven methodology to allocate surgical beds to surgical services based on the OR slate, historical bed utilization, and length of stay. It has two parts: “bed smoothing,” in which daily bed quotas are aligned with the master OR slate (this sets the number of permissible daily inpatient admissions in order to smooth the weekly census and stay within overall bed capacity); and “dynamic smoothing,” which allows the readjustment of incoming admissions based on real-time analysis of imminent bed requirements on the unit. The daily bed quotas methodology is well established, while the dynamic smoothing methodology is still undergoing refinements. These integrated methodologies are the first of their kind in Canada. PHC is the only health care organization locally, nationally and internationally to integrate and implement all aspects. These methodologies have been presented at national conferences, and several other jurisdictions are interested in following suit. Of note, surgical bed smoothing was built upon a hospital-wide system for Bed Allocation (BAM) that PHC invented within the region.
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