6 Ways to Improve ASC Efficiency Without Jeopardizing Quality

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Sherry Rogers, RN, CNOR, administrator of Tullahoma (Tenn.) Surgery Center, managed by USPI, discusses six ways surgery centers can improve efficiency without damaging patient care.

1. Create checklists for patient handoffs. Remove bumps from the turnover process by giving each staff member a checklist that identifies every task they need to perform before a case starts or a patient is moved to the PACU. "The checklists make my staff work so much closer because they know that things can't slip through the cracks," Ms. Rogers says.

"When the patient goes from the pre-op nurse to the circulator, or from the circulator to the anesthesia provider, or from the scrub nurse to the technician, everyone works so closely that they keep that communication." For example, a nurse might inform another provider of any patient abnormalities, such as an abnormal EKG or an issue that could potentially lead to a hospital admission.

2. Involve physicians in the checklist process. Let physicians know a case cannot start until staff members have completed their respective checklists. Talk to physicians as soon as they start bringing cases to the center, and stand firm on your policy. "Right off the bat, our physicians knew that when we start doing things, we're going to do it right the first time and not cut corners," Ms. Rogers says. "We were not going to let money compromise the safety and quality that the patients were going to get from us."

If her nurses tell the physician that he or she cannot start draping or cutting until the final checks have been performed, the physician listens. "The physicians are very open to the staff saying, 'You can't do that yet,'" she says.

3. Monitor physician late starts.
Ms. Rogers says her surgery center monitors late starts by physician and contacts each physician if he or she is running late. "Our surgeons allow us to text them — they don't like a lot of phone calls, so we will text them," she says. "If we see a physician is not here five minutes before the start time, we let them know they have five minutes to get here." She says she makes sure to call physicians if the schedule has been disrupted or changed and their case times will be moved back.

Make sure to track late starts per physician so you know where problem areas exist. There are many reasons for case delays, and it may not be clear that a chronically late physician is causing the problem rather than delays in room turnover.

4. Let anesthesiologists know of schedule changes in advance. Anesthesiologists can cause delays if they are unaware of scheduling changes, Ms. Rogers says. "We just make sure that they are aware of any changes in the schedule the next day," she says. "We've been very fortunate to be able to call them at any time, so we just keep them aware of the schedule."

She says it helps if your anesthesia providers are willing to field calls outside business hours or communicate via text message. Build a trusting relationship with your anesthesia providers by sending timely updates on scheduling changes. They will be more likely to show up to the center on time if they know the schedule will be accurate.

5. Keep operating rooms tidy during surgery.
Cleaning an OR is not much different than cleaning a home: Pick up messes as you go and you won't be left with an insurmountable cleaning task at the end of the day. Ms. Rogers says her nurses are careful to keep the OR as tidy as possible throughout surgery, thus speeding up room turnover. "The staff tries not to drop paper on the floor from the drapes," she says. "If there's something spilt on the floor, the circulator has it cleaned up. They try to keep the room as clean and tidy as they can during the case because they want minimum room clean-up time."

She says the staff also tries not to open any unnecessary supplies during the case. "We have a back hall where we keep supplies on a cart, so staff can easily reach the cart and get supplies," she says. "This way, the room is not cluttered with a whole lot of things that we need to take out between cases."

6. Optimize sedation to discharge patients faster. Ms. Rogers says her surgery center performs a lot of cataract and GI surgeries, meaning the anesthesiologist can give patients light sedation to speed up discharge. "We give such light sedation that patients are discharged within 45 minutes to an hour, as long as criteria are met," she says.

For orthopedic surgeries, her surgeons perform blocks so that the patients do not require pain medication in the PACU. Talk to your surgeons and anesthesiologists about the ideal sedation for each procedure. In some cases, patients may need more recovery time to ensure clinical quality; in other cases, lighter sedation is safe and effective and can prevent clogs in the PACU.

Related Articles on ASC Operations:
10 ASC Must-Reads From the Week of Oct. 24
6 Components of a Successful ASC Strategy
6 Ways Large Specialty Physician Groups Can Navigate the Next Few Years



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