Here are 10 of the most common issues that, when addressed, can make ambulatory surgery centers more efficient.
"ASCs want patients to have a positive, safe and expeditious event without feeling rushed or that they are waiting unduly," says Deb Yoder, MHA, BSN, RN, CNOR, director of clinical services, HIPAA and compliance officer for Surgical Management Professionals. "You want patients at the center and ready to go when the physician is ready to start the case. In turn you don't want patients arriving to early forcing them to have a long wait time before the case starts. It's a balancing act, all affecting positive patient outcomes and satisfaction. "
Here are common efficiency issues for ASCs and how to fix them.
1. Not tracking surgeon caseload. Keep track of how long it takes surgeons to perform each case, on average, to schedule enough time on the front end. "Surgeons think they can do everything in a half-hour, but in reality many cases take longer than that," says Ms. Yoder. "Keep track of the start and end times and schedule their cases in a consistent manner. This keeps patients happy — as they are not waiting on a case which ran over the scheduled time — and surgeons can use their time efficiently, not waiting on patients to arrive."
2. Lagging patient education. Conduct the patient education preoperatively and provide training before the day of surgery to avoid throughput issues on the day of surgery. "If there is someone who forgot to take their medications that morning or took the wrong dose, or didn't understand they weren't supposed to eat, you'll have to cancel that case and there will be block time open," says Ms. Yoder. "That's a break in the day which results in frustrated staff and lack of revenue, not to mention a dissatisfied patient and frustrated surgeon."
3. Patients waiting to be pain-free before discharge. Patients are more likely to recover and leave the surgery center in a timely manner if they have the right expectations for their postoperative condition. Educate them about discharge expectations and make sure they know experiencing some pain and nausea postoperatively is normal.
"If patients think they have to be pain free before they go home, they'll delay their postoperative time," says Ms. Yoder. "If they don't understand what is normal for postoperative patients, they'll be at the ASC all day. All staff want patients to meet discharge criteria and to go home in appropriate time frames. If patients don't understand post-surgery expectations, someone may think that they need to stay in postop for six hours, which creates prolonged postop care needs and changes efficient patient throughput. Have good education and insight on the front end so the back end will run smoothly."
4. Too few staff on schedule. Consider average case time when devising staff schedules to optimize staff utilization. "Is your center appropriately staffing on the front end and then shifting assignments to the postop area as patients move throughout the building? If you don't have enough staff to care for the patients in the appropriate area everything slows down," says Ms. Yoder.
5. Not having the right materials for special cases. If cases are scheduled that need special implants and those implants don't come through, cases are cancelled. "It's important to have someone watch that schedule or be responsible to make sure you have everything you need for that patient's procedure," says Ms. Yoder. It’s important for surgeons to know who to alert when special materials are necessary and promote communication.
6. Maxing out your schedule. Understand how much volume your center can handle on given day; this may mean you are creative with your staff and facility space use. Having a schedule with more local than general anesthesia cases doesn't mean you need less or fewer staff; it just means you might have more bodies moving through at a quicker pace.
During the fourth quarter it is not uncommon to max out your OR blocks, which means you may have to be creative with space for the patients in the perianesthesia areas. Higher volumes require more frequent turnover of rooms which takes time and energy, says Ms. Yoder.
"Consider your layout and the use of your rooms," she says. "Depending on the day and the resources, instead of a preop area and a postop area some patients may be able to use the same room for both needs, especially fast local procedures such as cataract, pain or GI. Having the patient use the same room for pre- and post-procedure needs alleviates moving patients to several rooms or moving families from preop to the waiting room and then to postop — all processes which take time and staff energy. If choosing to do this practice, one needs to ensure that all the appropriate equipment needs are in place and you are not providing care in an unsafe manner."
7. Layout of operating rooms. If you're building a new ASC, you can design the layout for optimal efficiency. In reality, many work in centers which may not have great layouts, especially if the building was originally used for a different purpose. If a center can think about the flow of both patients and staff it may limit the number of steps physicians and staff need to take to get the job done, which increases efficiency.
"Making ORs efficient for the surgeon and staff has great advantages," says Ms. Yoder. "If you have to walk back and forth across the OR 10 times to complete a given task, that's not a good sign. Think about where you are placing equipment and supplies."
8. Nurses in the hospital-shift mindset. If you're hiring nurses with previous experience in a hospital, educate them about the pace of an ASC. Nurses at hospitals are used to having patients around for longer periods of time. In a typical 12-hour shift they can stagger tasks and save charting to the end of their shift, or work at a 12-hour pace.
At ASCs, this is usually done in real time. ASC patients are rarely in the facility 12 hours and on a given day a postop nurse may have multiple patients to provide total postop procedure care in only a few hours. The pace is different at an ASC.
"You may be hiring great nurses, but these same great nurses need to understand at an ASC you only have a patient for several hours," says Ms. Yoder. "New staff need to be educated and understand the mission and goals of the ASC in order to provide efficient and effective care. This includes understanding that assessments, teaching, documenting and discharging patients occurs in the few hours they're at the center instead of over a 12 hour shift."
9. Treating all patients as if they have the same pain tolerance. When the nursing staff can identify the patient's pain tolerance preoperatively they can prepare their patients accordingly. "They'll understand which patients may need more education about pain control, alternative treatments or which patients may require additional recovery time," says Ms. Yoder. "Understanding patients' expectations and tolerance helps the staff know which patients might need additional attention and encouragement or may be at the ASC longer."
10. Poor communication. Make sure all staff understand what is going on in the building on a given day. Communicate schedules between the different departments in the ASC and update regularly. If a given surgeon is running late or ahead of schedule ensuring all areas aid in efficiency. Patients can be called to come in earlier, or educated about a late start. The information helps patients understand where they fit in the process which increases patient satisfaction. Staff can adjust tasks and time utilization is enhanced.