3 Ways to Improve Physician Start Times

According to Larry Teuber, MD, president of Medical Facilities Corp., late surgeons are one of the most significant causes of artificial cost increases. There are several costs associated with surgeon lateness: the cost of staff who have to wait longer, the cost of tearing a room down because the sterile room has been set up for too long and the cost of flipping rooms because the first surgeon's lateness interferes with another surgeon's scheduled case.

"You also have the cascading effect of a late surgeon as it relates to the following cases and those surgeons who are delayed, as well as the spillover expense of folks who are now staffed in recovery rooms," he says. Cascading delays can spill over into overtime, costing your surgery center more money and wasting valuable time, he says. Here he discusses three ways to improve physician punctuality.

1. Define "start time." According to Dr. Teuber, Medical Facilities Corp. conducted a poll that asked surgeons to identify the correct definition of "start time" out of a list of five selections:

1. Patient leaves pre-op
2. Patient enters the room
3. Anesthesia begins induction
4. Surgeon is called to the room
5. Surgeon starts the incision

He says the surgeons' responses ran the gamut, demonstrating that no clear standard existed. Different surgeons had different practices for interacting with the patient prior to surgery. "In the past, surgeons may not have seen the patient in preop before surgery, and now surgeons have to come in and sign the extremity [to decrease the incidence of wrong-site surgery]," he says. "So when you poll surgeons ages 30-60, the old ones show up in the OR according to the old rules, and the young guys think it's a matter of routine to have a discussion and confirm site of surgery." He says these differences make standardization all the more crucial.

"We now define start time as when the surgeon physically walks into the pre-op room and engages the patient in conversation," he says. "That's when the clock starts."

2. Establish expectations for the surgeon's arrival. Once your center has cemented a clear definition of "start time," you should implement a rule regarding the patient's status when the surgeon arrives. Dr. Teuber says his rule states that by the time the surgeon starts at 7:00 AM, he or she should have immediate access to the patient. The surgeon will then expect the patient to be prepared and will show up at the established start time knowing there will be no delays. "The chart has to be available with a pen on the consent form with the nurse at the door at the designated start time," Dr. Teuber says.

He says implementing these policies has brought surgeon complaints due to delays to almost zero.

3. Use peer pressure to discourage lateness. Even if a surgeon is habitually late, staff members may be hesitant to confront the surgeon because they fear retaliation. Dr. Teuber recommends publishing information on delays to all ASC surgeons. Once the information is made public, most surgeons will be much less likely to ignore start times.

If peer pressure doesn't work, he says repeated late surgeons have been fined. The money goes into an employee party pool or a lottery, allowing ASC staff members to benefit from the surgeon's mistake.

Learn more about Medical Facilities Corporation.

Read more on physicians in the ASC:

-10 ASC Best Practices From 10 ASC Physicians

-4 Core Things ASCs Should Benchmark

-8 Key Issues for Specialists

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