Take 'on-time' starts beyond the policy — 5 tips to actually start on time every time

Every ambulatory surgery center owner and operator knows how important efficiency is to their bottom line. On-time ASCs please busy surgeons, patients and nurses while also fitting more cases into a single day's schedule.

ASCs face several roadblocks for efficient on-time starts, including:

• Late patients
• Surgeons held up at the hospital
• Missing patient information
• Physicians and staff spending too much time in the break room
• Miscommunication

Late starts mean fewer cases are performed during the day. They can also hurt the ASC's bottom line because significant dollars are spent for every minute in the operating room. If the patient is ready, staff is set but the surgeon isn't prepared, those minutes turn into dollars lost.

Many surgery centers have policies for "on-time" starts. But that doesn't mean surgery always starts on time. Here are five tips for ASCs to go beyond the policy and actually start on time every time.

1. Define on-time starts and communicate them. Everyone from the scheduling and nursing staff to the anesthesiologists and surgeons should have a clear understanding what you mean by "start time." The start time could be defined as the moment patients are taken into the preoperative area, when anesthesia starts or when the surgeon makes the first cut. Minimize the confusion by defining the on-time starts and setting clear expectations on everyone's arrival time at the ASC from there.

Take the communication a step further with transparent data about how late starts impact the center. Show the surgeons how much it costs the center to hold the operating room for them when they're late. Additionally, provide information to staff members about how room turnover times can impact start times for cases later in the day and incentivize them to meet their benchmarks appropriately.

2. Schedule surgeons smartly. Take each surgeon's needs and preferences into consideration when scheduling their cases. Surgeons often prefer block scheduling. The rule of thumb for block schedule utilization is 70 percent to 90 percent — if the surgeon isn't using enough of their block time, its best practice to split the block with another physician or find a more convenient block for the surgeon to take over.

Work with chronically late surgeons to develop a better timeline to increase utilization. Some surgeons may need to start later in the day while others could take advantage of earlier times before heading to their clinic or hospital for larger cases. You can also give surgeons control over their block and scheduling within that space to optimize their time. Finally, some centers penalize surgeons who are chronically late.

Set a benchmark for how many cases your center needs per day and work with the physicians, nurses and schedulers to meet these goals.

3. Avoid delays and cancellations by doing as much work upfront as possible. This includes gathering patient information and history beforehand as well as making sure patients understand protocol prior to surgery. This could include a combination of phone calls to collect information as well as patient portal utilization so patients can enter accurate information online. However, none of this information will do any good unless the ASC can identify red flags and address them before the day of surgery.

Then make sure anesthesiologists have the preoperative work on the patients prepared early so the case is ready to start on time. Set the supplies the night before and share information about the next day's cases with nurses so they're prepared for the surgeon to begin as soon as he or she arrives.

4. Give appropriate incentives for staff to improve turnaround times and on-time starts. A recent study published in JAMA surgery shows financial incentives improved on-time starts and reduced room turnover times. After providing financial incentives for their team, the study authors at an academic trauma hospital found turnaround times were faster in 52 percent of the cases and on-time starts improved between 31 percent and 64 percent.

The program, however, was costly and ASCs may not see a huge benefit, especially if their center is already efficient. There are other types of incentives to promote good habits, including:

• Additional PTO days
• Center-wide parties or potlucks
• Catering lunch
• Leadership training/professional development
• Recognition such as "Employee of the Month"

5. Track procedure times and use that information when scheduling cases. If one surgeon is usually longer with knee scopes than another, take this information into consideration when scheduling cases. Additionally, it could be beneficial to show surgeons their operative times on similar cases and open a discussion about what the faster surgeon does differently. There may be process-oriented issues the slower surgeon could implement to make the most out of his or her operating room time. Naturally, ASC physicians do not want to compromise quality for efficiency, but an open discussion could prove beneficial for surgeons as well as the center.

Tracking cases can also show whether surgeons are scheduling their cases for the right amount of time. If the surgeon usually schedules 40 minutes for a case but almost always takes 60 minutes, you can count on delays. The scheduler should know the typical time surgeons take and update the schedule accordingly.

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