BNI-DHCI Block Time Operational Review

Executive Summary

This operational review examines the utilization patterns and efficiency of the dedicated 90-minute daily block time allocated by the Barrow Neurological Institute (BNI) to accommodate urgent/emergent Dignity Health Cancer Institute (DHCI) patients at the SJHMC facility. Our analysis of 29 days of operational data reveals opportunities for optimization that could enhance patient care delivery for both institutions while maintaining the collaborative spirit of our partnership.

Total BNI Time Committed 63.5 hours

Productive Treatment Time 13.8 hours (21.8% efficiency)

Urgent/Emergent DHCI Patients Served 62 patients

Patients Accommodated Within Block 36 patients (58%)

1. Block Time Implementation and Utilization

Daily Block Time Breakdown: Allocation vs. Utilization

Key Observations

Average Daily Block Allocation by BNI 77.6 minutes

DHCI Advance Scheduling Rate 62% of allocated time

Actual Machine Utilization 59.5% of scheduled time

Overall Block Efficiency 37% of allocated time

Our analysis reveals that while BNI has consistently provided block time allocation, DHCI's advance planning processes are deficient. The 38% gap between allocated and scheduled time demonstrates inadequate patient flow coordination and represents a substantial waste of allocated BNI resources.

2. Patient Distribution and Operational Impact

Patient Treatment Distribution

BNI Time Impact: Where 63.5 Hours of BNI Resources Went

37.5h

Block Time BNI Gave Up

13.8h

Productive Treatment

9.4h

Wasted in Block

26h

Extra BNI Time Taken

Total BNI Resources Committed

63.5 Hours

Only 21.8% Used Productively

Operational Impact on BNI

The 42% of urgent/emergent DHCI patients (26 patients) requiring scheduling during regular BNI patient hours or overtime periods directly displaces scheduled BNI patient treatments. This pattern is causing operational strain and reducing our capacity to provide timely care to our own patient population, despite the existence of dedicated block time specifically allocated for these cases.

Time Slot Analysis

Within Block Time

Patients Served 36 patients

Percentage 58.1%

Outside Block Time

Regular Hours Impact 13 patients

Overtime Required 17 patients

3. Clinical Scheduling and Cancellation Patterns

Scheduled vs. Actual Block Time Usage

Clinical Triage Assessment

The data demonstrates that DHCI's clinical triage process is problematic. With 390 minutes (27.9% of scheduled time) lost to same-day cancellations, predominantly due to medical instability, the current patient selection and assessment protocols are inadequate for effective block time utilization.

Cancellation Analysis

Primary Cancellation Reason Medical Instability (55.6%)

Total Time Lost to Cancellations 390 minutes

Impact on Block Efficiency 27.9% of scheduled time

The predominance of medical instability as a cancellation reason indicates inadequate pre-treatment assessment protocols. This represents a fundamental failure in clinical triage that must be addressed to achieve acceptable block time utilization and reduce operational waste.

4. Partnership Balance and Resource Utilization

Reciprocal Resource Utilization

Partnership Consideration

While BNI has allocated significant machine time and operational resources to support urgent/emergent DHCI patients, our records indicate that BNI has not utilized comparable resources at DHCI facilities during this period. This presents an opportunity to discuss resource sharing balance to ensure mutual benefit and operational sustainability.

Resource Allocation Summary

BNI Time Allocated to DHCI 2,250 minutes (37.5 hours)

Additional BNI Time Displaced 1,560 minutes (26 hours)

DHCI Time Utilized by BNI 0 minutes

Net Resource Exchange 3,810 minutes (63.5 hours)

Collaborative Enhancement Opportunities

Based on our operational analysis, we propose the following collaborative improvements to optimize patient care delivery and resource utilization:

Immediate Opportunities (Priority 1)

Enhanced Block Time Utilization: We respectfully request that all urgent/emergent DHCI patients be accommodated within the designated block time to minimize disruption to scheduled BNI patient treatments and maintain optimal care delivery for both patient populations.
Enhanced Clinical Triage Requirements: DHCI has an opportunity to improve its clinical triage and assessment process. The current 27.9% same-day cancellation rate, primarily due to medical instability, indicates deficiencies in patient selection criteria that must be addressed.

Strategic Considerations (Priority 2)

Right-Sized Block Allocation: Based on current utilization data showing an average of 28.6 minutes of actual daily usage with peak days reaching 80 minutes, we propose reducing the block allocation to 60 minutes daily. This would better align with actual patient volume (allowing for 48 minutes of productive time at 80% efficiency target) while maintaining adequate capacity for peak demand and improving overall resource utilization efficiency from the current 37% to a more acceptable 80%.
Resource Sharing Balance: Discussion of reciprocal resource utilization opportunities to ensure mutual benefit and sustainable partnership operations.

Partnership Sustainability

Monthly Review Process: Implementation of monthly operational reviews to monitor utilization patterns, identify optimization opportunities, and ensure continued alignment with both institutions' patient care objectives.
Performance Metrics: Establishment of mutually agreed-upon efficiency targets and success metrics to guide ongoing partnership optimization.

Proposed Review Timeline 30 days post-implementation

Conclusion

This analysis demonstrates BNI's commitment to supporting urgent/emergent DHCI patient care while highlighting opportunities for operational enhancement. The current 21.8% efficiency of allocated time suggests significant potential for improvement through enhanced planning processes and resource optimization.

We believe these collaborative enhancements will strengthen our partnership while ensuring optimal patient care delivery for both BNI and DHCI patient populations. We look forward to working together to implement these improvements and maintaining our shared commitment to excellence in patient care.