Brien Fausone, administrator of Michigan Endoscopy Center in Farmington Hills. Mich., offers six best practices to help ensure an efficient gastroenterology center.
1. Monitor block times. After the center has been launched and physicians are accustomed to their block times, the chief challenge in this area is responding to occasional requests by physicians to change their blocks or to shift around blocks to accommodate a new physician. Therefore, monitoring block time utilization by physicians is critical.
For example, "a physician wants time on Wednesday mornings and I look at the schedule and notice that a physician with a Wednesday morning block is not using it all the time," Mr. Fausone says. He would then start a dialog with the physician holding the block, asking him if he could hand over the block every other week. "Physicians tend to be agreeable about sharing block times because it is an opportunity to raise volume for the center," he says. It could boost overall ASC volume because the physician who needs more time may want to bring more cases over from the hospital.
2. Fitting in shorter procedures. Shortening some blocks for shorter procedures can boost daily volume. For example, many GI physicians can perform esophagogastroduodenoscopies in just 15 minutes, allowing the center to cut the usual 30-minute block in half. Physicians can double their volume by using the shorter blocks for EGDs. However, while some physicians welcome the opportunity to speed up their cases and get more done, others prefer a slower pace, with time to take a break between cases.
3. Contract for anesthesia. The use of contracted anesthesia personnel, either MDs or CRNAs, can help speed up turnover because patients recover faster under propofol used in this anesthesia. "In a busy ambulatory surgery center the turnover of beds is important for process flow and surgical schedule integrity," Mr. Fausone says. Some physicians still prefer to administer conscious sedation on their own or with a nurse, but these patients take about 45 minutes to recover and leave, compared with 30 minutes for patients sedated with propofol. Mr. Fausone suggests larger facilities should change to anesthesia but he recognizes that small ASCs may not be able to afford and thus may need to stay with conscious sedation.
4. Prescreen patients. ASC personnel do not want any last-minute surprises, such as finding out on the day of surgery that, due to health problems, the patient is not an appropriate candidate for surgery there. To make sure this does not happen, ASC personnel need to coordinate prescreening of the patient in cooperation with the physician's office. On the surgical boarding form filled out at the physician's office, there can be questions on the patient's past health issues, such as cardiac problems, that could be affected by anesthesia. A nurse from the ASC would then follow up with the patient.
"If the patient has had open-heart surgery and had a cardiac stent put in, we ask, 'When was the last time you saw your cardiologist,' " Mr. Fausone says. If it hasn't been for a while, the patient is required to see the cardiologist and get clearance. "It's an extra step that we take to ensure patient safety and determine if the ASC is the appropriate surgical setting for the patient," he says.
5. Install an EMR. Michigan Endoscopy Center has had an electronic medical record for five years. Unlike written records, the EMR is always legible, since information is keyed in, and there are rarely gaps in information because the system does not let entry proceed without filling out required blocks. The chart can be completed by the end of the day of surgery, compared with a few days for completing a paper chart.
EMRs have a downside, though. When automated systems crash, staff members have to revert to paper charts, which they may no longer be familiar with. However, "the inconvenience of system downtime is a small price to pay for a fully functional EMR and the benefits it provides," Mr. Fausone says.
6. Do one, see one. To prevent back up of patients in the recovery rooms, physicians shouldn't delay their post-op meeting with the patient before discharge. The mantra here should be, "do one, see one," which means document the clinical findings after the procedure; then, instead of going on to the next procedure, go see the next patient in the recovery room to discuss results of the exam and allow discharge to proceed.
Learn more about Michigan Endoscopy Center.
Related Articles on Efficiency in ASCs:
5 Reasons Why Surgeons Still Join Surgery Centers
Best Practices for Increased Efficiency at ASC Pain Management Centers
The Future of Physician-Owned Hospitals: Insights From Animas Surgical Hospital CEO Brett Gosney