Here are five ways for ambulatory surgery center administrators to promote on-time case starts.
1. Make sure staff and anesthesia is ready to go. Staff members and anesthesiologists should have the pre-operative work for the patient ready early so when the surgeon arrives the case is ready to begin.
"Our staff gets here an hour before the case is scheduled to start," says Keith Smith, MD, co-founder and Managing Partner of Surgery Center of Oklahoma in Oklahoma City. "All supplies for the cases are pulled the day before, and any regional anesthesia blocks that need to be done for a surgery are completed in the pre-operative area prior to the patient entering the operating room."
The patient's chart should be in order well before the case is set to begin so everyone is prepared for the on-time start.
2. Incentivize surgeons to arrive on time. One of the reasons for late start times at ASCs is late physician arrivals. Administrators who build a strong relationship with surgeons can more effectively communicate the necessity of on-time starts and physician arrival at the ASC.
"Talk with the surgeons directly about getting to the facility on time," says Dr. Smith. "We have a formula that assigns more of the fixed expense to surgeons who show up late or take too much time between cases. That adds to their portion of the fixed expense for the operations at the ASC, so that keeps everyone honest. There are financial consequences for surgeons who show up late or take too long between cases. However, rather than resort to that we like to have direct conversations with people who are not here on time chronically."
3. Rearrange block time. If a surgeon becomes chronically late, consider rearranging or revoking their block time so other surgeons can utilize the ASC. "The surgeon who is chronically late at our ASC loses their block time, or if they abuse it we will change it," says Dr. Smith. "We are in charge of the block schedule. We've never had to rearrange it, but something like that could happen."
Central Maine Orthopaedics also emphasizes the waste associated with unused block time and encourages surgeons to pass unscheduled time along to one of their partners. "When we first started block scheduling, a provider wouldn't give that up or allow anyone else to use their time," says Anne Marie Kayashima of Central Maine Orthopaedics ASC in Auburn. "Today, all of our providers would look for a way to share time and make sure the OR is full. It's not just about their productivity, but about the business. They are aware that keeping the OR full is best for the business."
4. Follow-up on cases where on-time starts are missed. Regularly report on procedure start times and investigate instances when the case starts late. "Our staff submits a daily report and gives reasons for case delays or problems with the transition," says Ms. Kayashima. "If we exceed the 15 minute turnover time, it's reported and we address the reason it occurred."
Administrators at the ASC follow trends very carefully and find a solution to issues with start times. "The biggest thing we've seen is periods of time where physicians under-book the cases, so they take longer than the scheduled time," says Ms. Kayashima. "We are also looking to increase the number of towers we have so we can do more arthroscopic procedures each day. Making sure you have the right amount of equipment can be very helpful."
5. Implement strategies for quick room turnover. Central Maine Orthopaedics has engaged in several strategies to speed room turnover, including cross-training employees and following checklists.
"We have trained multiple employees on how to clean the rooms," says Ms. Kayashima. "They are also writing down start times, when patients leave the OR and when a new patient is brought in. They know throughout the day what their turnover times are, and I think that facilitates a discussion about strategies for changing how they practice to improve efficiency."
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1. Make sure staff and anesthesia is ready to go. Staff members and anesthesiologists should have the pre-operative work for the patient ready early so when the surgeon arrives the case is ready to begin."Our staff gets here an hour before the case is scheduled to start," says Keith Smith, MD, co-founder and Managing Partner of Surgery Center of Oklahoma in Oklahoma City. "All supplies for the cases are pulled the day before, and any regional anesthesia blocks that need to be done for a surgery are completed in the pre-operative area prior to the patient entering the operating room."
The patient's chart should be in order well before the case is set to begin so everyone is prepared for the on-time start.
2. Incentivize surgeons to arrive on time. One of the reasons for late start times at ASCs is late physician arrivals. Administrators who build a strong relationship with surgeons can more effectively communicate the necessity of on-time starts and physician arrival at the ASC.
"Talk with the surgeons directly about getting to the facility on time," says Dr. Smith. "We have a formula that assigns more of the fixed expense to surgeons who show up late or take too much time between cases. That adds to their portion of the fixed expense for the operations at the ASC, so that keeps everyone honest. There are financial consequences for surgeons who show up late or take too long between cases. However, rather than resort to that we like to have direct conversations with people who are not here on time chronically."
3. Rearrange block time. If a surgeon becomes chronically late, consider rearranging or revoking their block time so other surgeons can utilize the ASC. "The surgeon who is chronically late at our ASC loses their block time, or if they abuse it we will change it," says Dr. Smith. "We are in charge of the block schedule. We've never had to rearrange it, but something like that could happen."
Central Maine Orthopaedics also emphasizes the waste associated with unused block time and encourages surgeons to pass unscheduled time along to one of their partners. "When we first started block scheduling, a provider wouldn't give that up or allow anyone else to use their time," says Anne Marie Kayashima of Central Maine Orthopaedics ASC in Auburn. "Today, all of our providers would look for a way to share time and make sure the OR is full. It's not just about their productivity, but about the business. They are aware that keeping the OR full is best for the business."4. Follow-up on cases where on-time starts are missed. Regularly report on procedure start times and investigate instances when the case starts late. "Our staff submits a daily report and gives reasons for case delays or problems with the transition," says Ms. Kayashima. "If we exceed the 15 minute turnover time, it's reported and we address the reason it occurred."
Administrators at the ASC follow trends very carefully and find a solution to issues with start times. "The biggest thing we've seen is periods of time where physicians under-book the cases, so they take longer than the scheduled time," says Ms. Kayashima. "We are also looking to increase the number of towers we have so we can do more arthroscopic procedures each day. Making sure you have the right amount of equipment can be very helpful."
5. Implement strategies for quick room turnover. Central Maine Orthopaedics has engaged in several strategies to speed room turnover, including cross-training employees and following checklists.
"We have trained multiple employees on how to clean the rooms," says Ms. Kayashima. "They are also writing down start times, when patients leave the OR and when a new patient is brought in. They know throughout the day what their turnover times are, and I think that facilitates a discussion about strategies for changing how they practice to improve efficiency."
More Articles on Surgery Centers:
8 ASC Administrators on Healthcare Reform
5 Tips for Success With GI-Driven ASCs in Competitive Markets
5 ASC Human Resources Functions to Automate With Big Benefits