Ann Geier, MS, RN, CNOR, CASC is senior vice president of operations and Susan Kizirian is chief operating officer for ASCOA.
Q: What is a good benchmark for waiting room times for patients after they check-in and before they go to pre-op?
Ann Geier and Susan Kizirian: This is probably the main complaint from patients on the patient satisfaction survey, so it's something centers should not ignore. It is difficult to give a firm goal for the time, as there are several factors that affect the times allotted.
· Physicians' request — Many physicians want patients brought in every 15 minutes so that they don't have to wait between cases. This is usually true of ophthalmology, GI and pain management physicians. They believe that they do cases so quickly, if we don't bring patients in every 15 minutes, they will have to sit and wait between cases. The reality is that they have cases that are longer than others, and this has a domino effect. Therefore, the patients scheduled third or fourth in line may start to have a longer wait, and this snowballs. We've seen patients have to wait two hours in the lobby or pre-op because of this. There are unforeseen circumstances that occur (i.e., a cancellation) and having the patients there early allows you to move them up, so you do need to consider this.
· Historical case times — Most computer systems allow the center to track historical case times per physician per CPT code. This allows the cases to be scheduled more accurately in the system, and arrival times can be adjusted accordingly. Physicians don't always believe these times, but data is powerful, and this can be discussed with physicians to help them understand why the center is scheduling arrivals as they do.
· Pre-op space may be limited — If this is the case, bringing the patients in early may mean that they are sitting in the lobby longer. They perceive this as a waste of time. The center can accomplish some tasks before bringing them to pre-op: taking vital signs, completing the pre-assessment paperwork, etc. When the patient is brought to pre-op, they can change clothes, take pre-op meds and have an IV started.
We think the main issue is knowing how quickly patients can be admitted, and knowing this by specialty. Take that into consideration and make sure the communication between patient, physician and admitting nurses is updated frequently.
We think that when a patient arrives at the center, they should be immediately acknowledged by the receptionist and checked in within 5-10 minutes of arrival. At that point, they would be told to expect to be taken to pre-op within 15-30 minutes (depending on specialty), and if it will be longer, someone will update them.
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