8 Steps to Quicker Turnover Time in ASCs
"I think you need people with really good critical thinking skills that understand if something happens where the patient or surgery is delayed, there is a ripple effect," says Mary Sturm, senior vice president of clinical operations at Surgical Management Professionals. "It doesn't just affect admissions if someone doesn't get through on time, but patients will be delayed all day. Staff members and surgeons have to see the big picture and use good decision making skills to appreciate how something might impact the surgery center."
Ms. Sturm discusses eight steps to tighten the turnaround time in an ambulatory surgery center.
1. Bring everyone on the same page with turnover time goals. Clearly define when the turnover starts and stops to measure the accurate timeframe and then set benchmarked goals for your staff to reach. When you are setting these goals, obtain input from the surgeons and staff members first.
"When someone says 'turnover time,' everyone should know what they are measuring and be measuring the same thing," says Ms. Sturm. "We find that some people think that turnover time starts when the surgeon leaves and scrubs out to when he comes back in again; others think it starts when the patient is brought into the PACU and the next patient is in surgery. Have a common description everyone agrees on before setting your goals."
The benchmarks for turnover time will be different based on surgical specialty. Gastroenterology and ophthalmology cases have a much quicker turnover time than orthopedic cases. "You have to look at the specialties you are performing at your surgery center and determine whether it's appropriate to come up with an overall average turnover time."
Continue a dialogue with staff members about meeting these goals and align their incentives appropriately. "I advocate for giving staff feedback on a regular basis and when they do meet goals, leaders should acknowledge them with a perk," says Ms. Sturm. "It could be something like sponsoring a lunch or just having ice cream. A lot of our centers are also fortunate because their employees participate in profit sharing, so there could be a financial incentive as well."
2. Streamline the admissions process. Surgeons, staff members and senior leadership must all be onboard with streamlining the admissions process to move patients through as quickly as possible. This means if there is a redundant form or test that really doesn't improve the quality of a patient care, consider eliminating that step and moving on to the next.
"For example, sometimes surgery centers have extra lab tests or an EKG that doesn't really impact the quality of patient care," says Ms. Sturm. "The decision to do these tests is driven by surgeon or anesthesiology preference. If those diagnostics are really going to be utilized to make decisions on the patient's plan of care, then they are important. However, sometimes they get ordered because they have always done those things and when people stop to think about it they don't use those results in the patient's care plan."
Audit your processes, either with internal personnel or hire an outside expert to look at workflow, and see where redundancies or unnecessary steps can be removed.
3. Improve communication between departments. One of the biggest factors in long turnover times is a lack of communication between different departments and disciplines within the surgery center. The front desk should be in constant communication with the pre-op area, operating room and PACU to make sure there aren't any patient delays.
"You want to avoid confusion and make sure everyone is on the same page about each patient," says Ms. Sturm. "Another thing that can interfere with quick turnaround times is when the patient is not ready in the pre-op area, wasn't admitted in a timely fashion or arrived late and still hasn't seen the anesthesiologist."
This all begins with efficiency in the preoperative area to make sure patients are prepped and ready to go when the OR is prepared. There are several different communication devices staff members and providers can use, with one of the most efficient being in-house cell phones.
"You can call in real time and have a conversation with the operating room staff about a specific surgeon or patient," says Ms. Sturm. "You can find out whether a surgeon is ahead of schedule to prepare patients to be brought in early. Real time communication among the charge people in each department brings everyone up to speed about the flow and how things are going."
4. Promote a dialogue between the OR and PACU. While communication throughout the ASC is important, it's particularly essential between the operating room staff and PACU. Sharp communication can mean a few minutes difference between each case because the staff members are alert to patient hand-offs and adequately prepared.
"If the PACU isn't ready to admit a patient and the anesthesia staff needs to wait around, that delays them getting onto their next case," says Ms. Sturm. "In our ASCs, the OR calls ahead to the recovery room when they are a few minutes away from bringing the patient. Then, the nurses are ready and waiting for us to admit the patient into the PACU."
Right after the anesthesiologist or CRNA hands the patient over to the PACU they can immediately go to admissions and retrieve the next patient.
5. Hire experienced anesthesia staff. Anesthesia impacts nearly every patient in the ASC. Ambulatory anesthesiologists must have high quality and efficient processes for working with patients.
"Your anesthesia staff should be comfortable and familiar with the routines in your surgery center," says Ms. Sturm. "They should be clinically good at what they do and put the patients to sleep and wake them up quickly. They are pulling on the rope like everyone else in being efficient."
It's important for the surgeons and other specialists to cooperate with the anesthesiologists and communicate effectively to ensure efficiency in the pre-op and post-op areas. "Good efficiency and quality anesthesia greatly impacts turnover times," says Ms. Sturm.
6. Cross train staff on turnover responsibilities. It's especially important to cross train staff members at ambulatory surgery centers because the team is lean, but every responsibility must be covered on a vacation or sick day. However, the cross training can also come in handy during regular days so staff members can recognize what needs to happen and complete the task, even if it is outside of their department.
"I think one of the things that is very effective for surgery centers is to create a culture where the different disciplines kick in for room turnover to get things done," says Ms. Sturm. "Sometimes in an OR in big hospitals, there are strict lines that nursing doesn't help anesthesia and vice versa; everyone has their job and they don't stretch out of that role. Surgery centers are encouraging staff to see what can be done and educating them about how to assist in getting it done."
With an extra set of eyes and helping hands, surgery center staff and providers can make sure everything gets done quickly and efficiently for the next patient.
7. Designate floaters if possible. The operating room should include experienced people who are very good at anticipating what the surgeon will need for surgery; however, sometimes they don't have enough time to do everything themselves. Have someone "float" from one room to the next to help people when necessary.
"One of the opportunities you have when people are designated to float in your surgery department is increased efficiency," says Ms. Sturm. "Those people can gather equipment for the next case and deliver information about where the patient is and how long it will be before they are ready for the next step in the process — it's a little bit of science and a lot of art."
8. Designate an extra room for surgeons. If your surgery center is in a position to provide surgeons with a second "flip" room, they can organize their surgery schedule to really improve efficiency. "If surgeons can do knees in one room and shoulders in another, that can be very efficient," says Ms. Sturm. "If you can't provide the surgeon with two rooms, you can give the OR managers a great deal of autonomy to arrange their surgery day in the most efficient manner possible."
Make sure that surgeries using similar equipment are all in a row so staff members aren't constantly moving equipment in and out of the OR several times per day.
As you can see, there are a number of opportunities to assist in reducing OR turnover time in your surgery center. If you don’t feel that you have the internal resources to work through these processes, look at hiring an outside expert to assist in workflow design and to assist in identifying redundancies or unnecessary steps.
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