Industry Standard for a 'Late' Surgery Center Case: Q&A With Paul Britt of Practice Partners in Healthcare

Industry Standard for a ‘Late’ Surgery Center Case: Q&A With Paul Britt of Practice Partners in Healthcare

Paul Britt is vice president of operations for Practice Partners in Healthcare.

Q: Do you know if there is an industry standard for what is defined as a “late” case in an ambulatory surgery center? We’re working on some internal benchmarking and wondering what we should be referring to as a “late-starting” case. If the case starts just five minutes late or even one minute late, should we still consider it late? We assume most ASCs can make up lost time in their daily schedule for cases starting between 1-20 minutes late but if this is a recurring trend, it would certainly become more difficult.

Paul Britt: The industry goal is 100 percent on-time starts; however, this is a difficult task to achieve. The reality is that delays are tracked in five minute increments to the 30-minute delay range. The delays are tracked by surgeon, anesthesia, patient, center and other. It is important to track the root cause of the delay so that corrective actions can be formulated and implemented. Since most case types in surgery centers occur at a higher frequency, the center team members can usually handle delays and recover over a very limited number of cases. Often in ASCs the turnover time and pace allows for minor delays to be absorbed in the normal routine during the day. Communication to the staff and the surgeons are key elements to advance the recovery of time. The team will also consider the order of cases to assure that equipment availability and sterilization schedules allow for any proposed changes.

Practice Partners has a written policy in place at each center that makes it clear when a case is late. It states, “Patients should arrive early enough to allow time to complete all pre-operative requirements for the procedure planned. This allows the staff and nurse manager the latitude to make arrival adjustments based on case type and complexity as well as patient history and anesthesia needs. If a patient does not arrive at the facility within 15 minutes prior to his/her scheduled procedure time, the proposed operative procedure may be canceled. Schedule permitting, the case may be rescheduled for the same day.” The policy is established to give guidelines for actions and the reality is the entire team works to maintain the patient flow and case performance.

Normally the nurse managers and administrators manage delays hands-on more routinely than going very specifically by this policy. And, for a given ASC, 10 minutes or 20 minutes may work better. Again, it’s finding that point where “late” turns into “too late to recover.”

One of our centers has adopted an internal standard of 10 minutes and an external of 20 minutes. External meaning if a physician was 20 minutes late the case may be bumped so the next case wasn’t held up. Internal means we didn’t get the case started on time from an operations standpoint and the delay was not patient arrival or surgeon delay.

This standard is a measurement that should be continuously evaluated and communicated to both staff and physician utilizers. ASCs should strive to start every case “on time”, meaning the schedule time as start time, so have the patient in the room and ready to start the case on the actual scheduled time. If this occurs after the scheduled time, then tag it as late — one minute or 20 minutes, doesn’t matter. If cases are consistently running late, adjustments need to be made. The benchmark should be “100 percent on-time starts”.

Learn more about Practice Partners in Healthcare.

Read more from Practice Partners in Healthcare:

– 5 Steps by a Management & Development Company to Facilitate Change in a Surgery Center: Q&A With Larry Taylor of Practice Partners in Healthcare

– 3 Ways Health Plans are Corralling OON Surgery Centers Into Their Networks

– 2 Examples When Out-of-Network is a Surgery Center’s Only Option

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