Joyce (Deno) Thomas, RN, BSN, is senior vice president, operations, for Regent Surgical Health.
Q: Our ambulatory surgery center is trying to determine our average hours per case. Who and what activities should be included in the formula?
Joyce Thomas: What we do at Regent is each of our facilities has average hours per case individually established. We look at, over a period of a quarter, what were the total number of cases and then by specialty. What percent of that total was orthopedics, spine, pain, GI, ENT, etc.? Then we do a weighted average. Considering the acuity, intensity and the labor requirements for specialties such as orthopedics, spine and ENT, we allow 14 hours per case. The 14 for ENT is because it's mostly pediatrics cases and you have to do one-on-one recovery with children. Then we go down from there. General and GYN — we say 12 hours per case. Then for pain, GI and ophthalmology, it is 10 hours per case.
What we include in those hours per case is the entire building. Some would argue against that, but somebody has to pay the salaries. At some point if you're not going to include your business office and leadership, then your hours per case should be radically lower than those figures.
But that's the benchmark we use. It's a weighted average based off the total number of cases, what percent were in each of the specialties and each specialty is assigned a benchmark of hours per case. When you do that weighted average for your facility, then you can come up with your own average hours per case. We have one facility that's 100 percent orthopedics and they're at 14 hours as their benchmark. Trying to say they need to get under 10 hours — which is a figure often suggested as an industry standard — when they have to have two scrubs and the cases are longer, it's not going to work.
Looking at industry standards is going to be hard. I think every management company does look at it from a different perspective and they typically don't do a weighted average based on acuity.
There's different methodologies you can use, different ways of looking at it. We have taken out business and management. We have looked at just operating room time and then you don't include anything else. My argument against that was what's to prevent you then from bringing in patients a few hours ahead of time and not being efficient, or not being efficient in your recovery or looking at anesthesia practices that will delay recovery? This is why we include the entire facility.
When calculating hours per case which includes the entire facility, remember that you start prepping for patients several days out. You have hours applied to that patient that is more than just the day-of the case when the patient is in the building.
Also, if you look at just the business office perspective, you can have orthopedic workers' comp or auto accidents. Where verifying a case might normally only take five minutes, these could take an hour or two on the phone by the time you get authorizations, dated claim numbers and ensure there are funds left. Even their time can be added up. When you look at hours per case, it's not just clinical that can be impacted by the type of case.
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