Sandy Berreth, RN, MS, CASC, administrator of Brainerd Lakes Surgery Center in Baxter, Minn., and Vicki Edelman, administrator of Blue Bell (Pa.) Surgery Center, discuss 10 ways their surgery centers improve efficiency.
1. Send out start times the day before surgery. Ms. Berreth recommends administrators send out surgeon start times the day before surgery via email. Most surgeons have regular access to email, and a reminder can help improve timeliness and eliminate the excuse of, "I didn't know."
2. Ask surgeons to do paperwork in advance. Ms. Edelman says her surgery center asks surgeons to prepare the necessary paperwork before arriving at the ASC. "You don't want the doctor to come in on the day of service and do an H&P," she says. The chart should be ready to go as soon as the physician walks into the center, and consent forms should be signed beforehand. She says her center has been successful in training physicians to complete paperwork ahead of time by introducing the policy as soon as a physician starts at the center and then staying firm on the expectations.
3. Use a "reservation sheet" to check supply needs. Ms. Berreth says her ASC asks physicians to fax over a reservation sheet that lists every supply the surgeon needs for the case. Surgery centers can improve efficiency if the right supplies are waiting for the surgeon when he or she arrives. That way, staff members don't have to scramble to stock the OR at the last minute, and the physician is ready to start the case as soon as the patient is ready. "It works really well to keep everybody on the same page," Ms. Berreth says.
4. Find an efficient anesthesia group. An efficient anesthesia group can speed up case transitions tremendously, Ms. Edelman says. Make sure to ask questions about efficiency and the group's philosophy during the interview, and check references to determine whether other facilities have had problems with the group's timeliness in the past. Ms. Edelman recommends speaking with the anesthesiologists as a group, as the opinions of the group's medical director or leader may not match the attitudes of each individual provider.
5. Penalize late starts. Physician tardiness can have a significant effect on efficiency, as one late start pushes back other cases and slows down the whole day. Ms. Edelman's surgery center has instituted a policy that penalizes physicians if they show up late three times. "If you are late three times, you will not get an early morning start," she says. She says the penalty comes down to a board decision, and the ASC has been firm about enforcing the policy with chronically late providers.
6. Don't keep the patient waiting. Ms. Berreth says her surgery center tries to let the patient sit in the waiting room for no more than five minutes. "It's important that they don't think, 'My appointment was for 8:30, so why am I still sitting here at 8:45?'" she says. If a staff member doesn't come to collect the patient within five minutes, the surgery center makes a second call to the pre-op area. Ms. Berreth's ASC also pre-assigns rooms to make sure staff members know where to take the patient.
7. Do the same thing every time. Ms. Edelman says surgery centers can improve efficiency by establishing policies and following those policies for every appropriate case. For example, ASCs should try to get room turnover down to a science; every staff member should know what he or she is responsible for and should not need to consult anyone to complete those tasks. For example, Ms. Berreth says during room turnover, ASC staff members should know exactly how to clean instrumentation and who is responsible for getting it done.
8. Improve hand-offs with consistent communication. Ms. Berreth's ASC has improved hand-offs from pre-op to OR and from OR to phase one recovery by developing a one-page worksheet for nurses to follow. The sheet lists the patient's vital statistics, the presence of the H&P, any patient allergies and the surgical site. "It's a one-page document, which helps because the OR nurse isn't having to look through the whole chart to find the necessary information," Ms. Berreth says.
9. Use a float nurse to handle turnover. Ms. Berreth says her surgery center uses a float nurse to handle tasks between cases. She says float nurses can be very helpful when other providers are busy with cases. "I have a two-minute average turnover time for ophthalmology and a five-minute turnover for orthopedic cases, and one reason is because I have a float nurse who does all that stuff in between cases," she says. While a float nurse costs the surgery center more money, Ms. Berreth considers the investment worthwhile.
10. Don't assume EMR will solve your problems. If you want to improve your surgery center's efficiency, don't assume that implementing an electronic medical record system will immediately speed up wait times and case length, Ms. Berreth says. "It doesn't necessarily work," she says. "EMRs are more difficult to handle because you're constantly clicking and saving." While EMRs can effectively improve patient safety and organization in an ASC — and are worth considering — don't depend on them to fix efficiency problems.
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1. Send out start times the day before surgery. Ms. Berreth recommends administrators send out surgeon start times the day before surgery via email. Most surgeons have regular access to email, and a reminder can help improve timeliness and eliminate the excuse of, "I didn't know."
2. Ask surgeons to do paperwork in advance. Ms. Edelman says her surgery center asks surgeons to prepare the necessary paperwork before arriving at the ASC. "You don't want the doctor to come in on the day of service and do an H&P," she says. The chart should be ready to go as soon as the physician walks into the center, and consent forms should be signed beforehand. She says her center has been successful in training physicians to complete paperwork ahead of time by introducing the policy as soon as a physician starts at the center and then staying firm on the expectations.
3. Use a "reservation sheet" to check supply needs. Ms. Berreth says her ASC asks physicians to fax over a reservation sheet that lists every supply the surgeon needs for the case. Surgery centers can improve efficiency if the right supplies are waiting for the surgeon when he or she arrives. That way, staff members don't have to scramble to stock the OR at the last minute, and the physician is ready to start the case as soon as the patient is ready. "It works really well to keep everybody on the same page," Ms. Berreth says.
4. Find an efficient anesthesia group. An efficient anesthesia group can speed up case transitions tremendously, Ms. Edelman says. Make sure to ask questions about efficiency and the group's philosophy during the interview, and check references to determine whether other facilities have had problems with the group's timeliness in the past. Ms. Edelman recommends speaking with the anesthesiologists as a group, as the opinions of the group's medical director or leader may not match the attitudes of each individual provider.
5. Penalize late starts. Physician tardiness can have a significant effect on efficiency, as one late start pushes back other cases and slows down the whole day. Ms. Edelman's surgery center has instituted a policy that penalizes physicians if they show up late three times. "If you are late three times, you will not get an early morning start," she says. She says the penalty comes down to a board decision, and the ASC has been firm about enforcing the policy with chronically late providers.
6. Don't keep the patient waiting. Ms. Berreth says her surgery center tries to let the patient sit in the waiting room for no more than five minutes. "It's important that they don't think, 'My appointment was for 8:30, so why am I still sitting here at 8:45?'" she says. If a staff member doesn't come to collect the patient within five minutes, the surgery center makes a second call to the pre-op area. Ms. Berreth's ASC also pre-assigns rooms to make sure staff members know where to take the patient.
7. Do the same thing every time. Ms. Edelman says surgery centers can improve efficiency by establishing policies and following those policies for every appropriate case. For example, ASCs should try to get room turnover down to a science; every staff member should know what he or she is responsible for and should not need to consult anyone to complete those tasks. For example, Ms. Berreth says during room turnover, ASC staff members should know exactly how to clean instrumentation and who is responsible for getting it done.
8. Improve hand-offs with consistent communication. Ms. Berreth's ASC has improved hand-offs from pre-op to OR and from OR to phase one recovery by developing a one-page worksheet for nurses to follow. The sheet lists the patient's vital statistics, the presence of the H&P, any patient allergies and the surgical site. "It's a one-page document, which helps because the OR nurse isn't having to look through the whole chart to find the necessary information," Ms. Berreth says.
9. Use a float nurse to handle turnover. Ms. Berreth says her surgery center uses a float nurse to handle tasks between cases. She says float nurses can be very helpful when other providers are busy with cases. "I have a two-minute average turnover time for ophthalmology and a five-minute turnover for orthopedic cases, and one reason is because I have a float nurse who does all that stuff in between cases," she says. While a float nurse costs the surgery center more money, Ms. Berreth considers the investment worthwhile.
10. Don't assume EMR will solve your problems. If you want to improve your surgery center's efficiency, don't assume that implementing an electronic medical record system will immediately speed up wait times and case length, Ms. Berreth says. "It doesn't necessarily work," she says. "EMRs are more difficult to handle because you're constantly clicking and saving." While EMRs can effectively improve patient safety and organization in an ASC — and are worth considering — don't depend on them to fix efficiency problems.
Related Articles on ASC Operations:
7 Best Practices to Create Goals and Objectives for a Surgery Center
15 Statistics on Surgery Center Net Revenue
6 Best Specialties for Surgery Centers