Dawn Q. McLane, RN, MSA, CASC, CNOR, is regional vice president of operations for Health Inventures.
Q: We think it might be time for our ambulatory surgery center to expand and add an operating room. How do we know if it's the right time?
Dawn McLane: If you're not able to get physicians on the schedule and you're managing your block time so that you're not sitting on holes in the schedule, it's likely time. By sitting on holes I mean that you have physicians who have block time but they're not filling it consistently. This leads to downtimes between cases where one physician is finished but he didn't use up his whole block and it's not time for the next one to start yet, which creates a gap.
Use your utilization [data] and physician feedback about their ability to get on to the schedule. Try to manage the schedule itself the best you can until you get to the point where when a physician says 'I can't get on the schedule' and you can't figure out how to get him on either. Once you are utilizing your time efficiently, you don't have those kinds of gaps in your schedule and you can't get physicians into open time, then you know you've probably maxed out your ability and can look into expanding.
Some ASCs build out a "future" OR which only requires equipment when the center has case volume to support it. Now may be the time to open that room, starting with part of the week and then expanding into additional days as the schedule requires.
But if you need to do physical expansion to add an OR, you need to be certain you have the volume and that you're not just anticipating that "if you build it, they will come".
You also have to give consideration as to whether you have enough pre-op and recovery beds. Some states have licensure requirements. You may be required to have a certain number of recovery room beds for each OR and if you don't have that, you can't build the OR or you would be required to add on to recovery as well in those situations.
All of these needs must also be taken into consideration before you build another OR. Can you process the additional instruments? Do you have the space for pre-op and recovery care for the anticipated volume and case mix? Do you need to make any changes to meet licensure requirements? These are just some of the questions you need to consider and potentially address if you are considering expanding your schedule and/or your physical plant to support an expanded schedule.
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