Lightning Quick Turnover Time & Effective Case Scheduling: Lessons From a High-Volume Endoscopy Center
Andrew Weiss, administrator of The Endo Center at Voorhees (N.J.) and treasurer of the New Jersey Association of Ambulatory Surgery Centers, sheds light on his center's strategies.
Mr. Weiss's center aims for an average turnover time of six to seven minutes. Here are six considerations for an ASC team working to meet its ultimate turnover goal.
1. Case load. At a single-specialty center many cases require the same type of equipment. In the case of an endoscopy center, almost all cases hinge on scopes. "On a very busy day you may not have a scope available immediately," says Mr. Weiss. Physicians may have to wait between cases for the next available scope, a considerable hiccup in smooth turnover time. Avoiding this situation begins with scheduling and a firm grasp on center's capacity for volume. The ideal scheduling strategy allows for a high number of cases without derailing smooth turnover.
2. Physician preference. Accommodating physicians' scheduling preferences and needs is an important aspect of running an ASC, but it may require some physician education. "Physicians tend to look at procedure time as time of scope insertion to removal," says Mr. Weiss. "They may forget turnover time." Physicians sometimes think they can book cases much closer together than is really possible. Management these expectations to keep ASCs on schedule, while still striving to be the best possible environment for physicians.
3. Infection control. Turnover is about speed, but not without efficacy. ASC staff turnover a room to ensure it is ready and clean for the next case. "From an infection control standpoint we need to focus on separating the clean and the dirty," says Mr. Weiss. At The Endo Center of Voorhees the manger of technical service oversees a team of 17 endoscopy technicians and room cleaning technicians, each responsible for preparing the scopes and rooms quickly and safely.
4. Staff coordination. Turnover time is entirely dependent on ASC staff members' ability to work in tandem with one another. "A well-trained staff is our number one driver," says Mr. Weiss. "We invest in training."
Most of the staff at The Endo Center at Voorhees has been promoted from within. The center offers its staff upward mobility, and in turn staff members are attuned to the center's specific needs. "We work to have our staff know our ways from the beginning, as opposed to retraining staff that learned at another center," he says.
5. Facility organization. Three years ago, The Endo Center at Voorhees moved to a new facility. The move allowed the center's leaders to take a close look at layout and organization. "We tried to keep the layout, and our staff's movements, as ergonomical as possible," says Mr. Weiss. Each OR and procedure room is uniform. All supplies are kept in the same place, saving precious seconds of searching. Even facilities that do not move can reevaluate existing organization and tweak it to shave seconds, or more, off of turnover time.
6. EMR. The Endo Center at Voorhees adopted an electronic medical record in 2004. After a six to nine month learning curve, the EMR became an invaluable tool. Physicians dictate in the operating room and electronically complete the procedure report. "From a medical records standpoint, it has saved us time, space, money and boosted productivity," says Mr. Weiss. Though not directly tied to the technical aspects of room turnover, EMR has improved the endoscopy center's workflow from a documentation, regulatory and billing standpoint.
Case scheduling is a delicate act of juggling physician need, patient need and a center's ability to accommodate. "We look at case mix vertically and horizontally," says Mr. Weiss. "Not only at OR, but we look across all six." Though not a simple task, this gives a complete picture how and when a center can fit its impending cases.
Effective case scheduling hangs in the balance between an ASC and its physicians' offices. The key is to establish open, frequent communication. "We are fortunate in our schedulers and the communication they have with physician practice schedulers," says Mr. Weiss. "They understand our parameters."
Even with careful coordination between ASC and physician office schedulers, there is still the possibility for patient cancellations. While not entirely in an ASC team's control, patient cancellations can be mitigated. The Endo Center of Voorhees policy is to reach out to patients three times prior to a patient's scheduled procedure: once through either online registration or a phone call and two phone calls for insurance verification and arrival time confirmation. "We keep our cancellations at a pretty steady 6 percent," says Mr. Weiss. The center tracks and managers case cancellations on an individual physician basis.
The center has a 7 a.m. start time. To ensure a punctual start, patients scheduled at 7 a.m. and 7:30 a.m. are asked to arrive at 6:15 a.m. If one patient is late or cancels, there is another ready to begin the center's day on time. Overbooking cases can be used to mitigate the impact of patient cancellations, but it should be used with caution. If there are no cancellations on an overbooked day, an ASC may struggle to handle the case load.
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