222 hours per day saved across 7 facilities, 73 ORs


The impacts the global pandemic has had on surgical services is significant and widespread. Cancellations and delays in elective surgeries have created enormous backlogs of cases, resulting in patients having to wait months for their procedures. Surgical staff members are often being asked to work overtime to handle the load and frustrations mount on both sides.

In a recent webinar, perioperative executive directors from Cone Health, an award-winning, not-for-profit health system in North Carolina, shared their approach to creating extreme efficiencies that helped their organization work through their case backlog in 1/3 of the time they originally anticipated. Here are the highlights of their story:


Primary Objective: Improve the Patient Surgical Journey — Without Exposing PHI

Cone Health wanted to minimize the surgical services work disruptions that can delay procedures and lead to preventable errors in the patient surgical journey. The manual scheduling communications tools employed to keep operating room team members informed included pagers, fax, text, email — and a printed schedule that always concerned Cone Health co-executive director of perioperative services Sharon McCarter: “You never knew whose hands that was going to fall into,” she says.

In addition to the risk to patient privacy their communications process posed, one missed touchpoint could lead to errors and delays detrimental to their surgical journey. With so many touchpoints, that risk was always high.

To begin to address these challenges, Cone Health implemented RelayOne in its Surgical Services department in 2019. And then COVID hit. All OR procedures were paused from March to June 2020, and by then, the system was facing a 6,000-case backlog.

Unexpected Benefit: Cone Health Quickly Retired Its COVID Backlogs

Wayne McFatter, co-executive director of perioperative services at Cone Health, says the backlog count didn’t include the normal demand for procedures, which was making a fast comeback. His team estimated 8 to 12 months would be necessary to meet that demand and catch up on paused cases, a fiscally painful timeframe considering the average hospital relies on the OR for 60% of its revenue.

The timing of the RelayOne implementation proved advantageous. The mobile-first solution delivers all OR scheduling communications via each team member’s smart phone. McCarter says this allowed them to minimize touchpoints and “eliminate the worst disruptions, because we had that secure information in the palms of our hands. Our external and our internal notifications became more transparent and, of course, accurate.”

Utilization Significantly Up

With RelayOne in place, all members of Cone Health’s Surgical Services care teams got up-to-the-minute notifications of changes and cancellations. Surgeons could see their schedules at a glance, identify usable gaps, and work with schedulers to get procedures booked in open slots.

The result was a significant boost to utilization and a reduction in that projected backlog timeframe from a year down to four months. “We were caught up by October 2020, the end of our fiscal year,” McFatter reports.


Time Required per Team Member Down

Members of Surgical Services benefitted from average daily time saved per user of 34 minutes. Extended across the system, this totals 222 hours per day, adding more time for care teams to focus on patient-centric tasks and improving the patient journey.

A Path toward Continuous Improvement

In addition to the extreme efficiencies enabled by RelayOne, McFatter values its analytical dashboard capabilities. These enable real-time reporting around metrics like first case on time starts, all cases starting on time, productivity for the day, utilization, turnover times to the second. This allows him and his care teams to know how they’re tracking against the day. For example, he says, “we can see our turnover time for the current day has been X minutes and determine if that needs to decrease in order to meet today’s goals. With Epic that’s not possible, since you have a one- to two-day lag in feedback.”

A Very “Popular” App

The popularity of the RelayOne app is evident according to McFatter. His team’s end user survey reports the user adoption rate at 96%, and requests to participate come in daily from physicians, vendors and other Surgical Services staff. Cone Health is now extending use to other procedural areas, including interventional cardiology and the catheterization lab.


Learn how health systems view the stubborn challenges to efficiencies in surgical services. Click here to read our blog covering independent research on the topic.