Maximize ASC OR Time: 10 Key Concepts
1. Benchmark for schedule optimization. Pay attention to case statistics and employee payment to find the number of paid hours per case for your organization. Benchmark that number to find the threshold where you are most profitable.
"We have an easier time hitting the profitability benchmark if we have 15 cases scheduled per day," says MedHQ CEO Tom Jacobs. "There is a drop-of in profitability if we are over or under that number. We let everyone know that and try to coordinate appropriately."
The ASC can still accommodate for special cases, but largely tries to schedule 15 or more cases per day. "Once we communicated with the schedulers and doctors about these benchmarks and the impact of a slower day versus a bigger day, they were in tune with us and wanted to help us make things as efficient as possible," says Mr. Jacobs.
2. Communicate gaps to other surgeons. There should be constant communication between ASC schedulers and physician practice schedulers, especially during vacation or meeting season. Ask practice schedulers to inform the ASC when the surgeon takes time off so you can give their time to other surgeons that week.
"We have to set up at the beginning of the day and take down at the end, so we want as many cases as possible in the middle," says Mr. Jacobs. "We want to keep surgeons and patients happy as well, so we communicate with them about vacation time and make sure we can fill those gaps when necessary."
3. Book opposite specialties together. If a center books all high-volume specialties at once, such as all GI cases, the flow of patients can overwhelm the recovery area. To assure a steady flow of patients through the center, match GI or other high-volume cases with lower-volume cases, such as orthopedics, where cases take longer and patients don't back up as much. Another example would be matching pain, a high-volume specialty, with ENT, which is lower-volume.
This tactic can be challenging. Matching specialties requires physicians to shift around schedules, which many of them are reluctant to do. It's important to help physicians understand why you need this kind of flexibility.
4. Streamline patient intake and throughput. Turnover time, though central to the operating room, does not begin there. "The key is getting the patient to the intake area in a timely fashion and making sure the flow out of the operating room to the recovery room is continuous," says gastroenterologist Larry Good, MD.
Surgery centers need to have in place a system for organizing and preparing paperwork. The quicker bureaucratic tasks are finished, such as paperwork, the more efficiently patients can be expedited to and from the OR. Consider online registration to eliminate some of the manual paperwork. "All of the information can be at the scheduler's fingertips," says Dr. Good.
5. Organize case information the day before. Central Maine Orthopaedics has a strict schedule of preparing patient charts 24 hours before the scheduled surgery time and the secretary gives patients calls to gather patient histories and other imperative preoperative information.
"We want to do all of the prep work ahead of time so they hear all the information three or four times," says Anne Marie Kayashima, Ambulatory Surgery Center Manager of Central Maine Orthopaedics ASC and Maine Spinecare Clinical Coordinator. "That way they are prepared for their day of surgery. They will arrive on time and then the staff can work together to make sure the case runs smoothly. We also discuss the discharge process ahead of time, which affords us a staffing matrix that is lean but highly skilled."
6. Add a washer and dryer. Evalyn Cole, CEO and administrator of Spine Surgery Center of Eugene (Ore.) added a washer and dryer to her surgery center so the nurses could launder scrubs in between cases. This way a sterile environment is maintained at the ASC and nurses can quickly begin their cases when they arrive at the center.
"We have added a washer and dryer and our CNAs launder the scrubs between cases," says she says. "This reduces laundry costs and extends the life of the scrubs, since they are not washed in the harsh chemicals used by commercial laundry."
7. Optimize nerve block quality and administration. Anesthesia providers can improve nerve blocks, thus improving the patient experience and shortening turnover times. Centers that do a lot of orthopedics include nerve blocks before the procedure. Doing those blocks in the OR takes up valuable time; instead, anesthesiologists can do the nerve blocks in the pre-op area and dedicate an anesthesiologist to prepare patients for surgery. This expedites the preoperative process so patients are ready for surgery when they get to the OR.
8. Update physician preference cards regularly. Staff should also review physician preference cards ahead of time so everything is present before the case begins. "Preference cards should be correct so there isn't anything you have to run and get at the last minute," says Sheila Stone, a surgery consultant at Soyring Consulting. "Train your team so everyone is working at the same time."
9. Centralize supplies and limit inventory in ORs. Supplies can be moved out of the ORs and were centrally located, such that turning them and reducing par levels could be easily controlled, says Anne Dean, RN, BSN, LRM, CEO and co-founder of The ADA Group. All supplies for the center can be treated in this manner, with the exception of those supplies only used in certain areas, such as peel packs for the sterile processing area.
Thus, all inventories are conducted out of the bulk and sterile storage areas, excepting those specialized items stored in those specialized areas. This keeps supply costs down significantly and reduces manpower hours in conducting weekly inventory and re-ordering of supplies.
Operating rooms can be equipped with one supply cupboard and one case cupboard. Limit inventory for supply cupboards to only those items that were essential as back-up for items already pulled for that room's cases.
10. Develop "room turnover packs." As part of the process for rapid room turnovers, have the staff develop a system for "room turnover packs." They include the OR table/bedsheet, the draw sheet, the kickbucket liners, and the various hamper liners. Assign staff to make these packs daily by gathering all the items and making rolls that are held in place with a strip of masking tape, says Ms. Dean.
These can be kept at the OR control desk. When pulling cases, the staff person would pull however many rolls were needed, based on the number of cases scheduled for that room the next day. One of the rolls was placed on each shelf with the supplies for the case.
Once the room is cleaned, the RN or other staff person — as agreed upon in their assignment meeting — pulls the roll, make the table/bed and place the liner in the appropriate spot. The surgical technician pulls the pack and places it on the back table and begins draping the instrument table and mayo stand. The RN circulator begins assisting in the opening of sterile supplies and dropping them onto the sterile field while the surgical technician scrubs.
The RN then sets up the prep table and leaves the room to collect the patient with the anesthesia provider. Upon re-entering the room, the RN finishes gowning the tech and physician and turn to assist anesthesia in sedating the patient as needed.
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