Issue link: https://beckershealthcare.uberflip.com/i/148060
ASC Turnarounds: Ideas to Improve Performance 10 Tips to Make Efficient ASCs Even Better (continued from page 1) "I conducted a QA study when we were encountering surgeons who were estimating inaccurate times," says Mr. Bernhardt. "We had a group of surgeons that were underestimating them, and with our limited schedule, following those surgeons was creating inefficiencies. We monitor them closely and direct our schedulers to add time to those surgeons' cases." Mr. Bernhardt might add 30 minutes to a surgeon who is consistently slower than estimated times so the schedule is more appropriate. "There can be no gaps in between cases," he says. "We look at our schedules daily and weekly and I have the power to readjust them and move the surgeries around so they flow smoothly and have no gaps." 2. Allow for early starts. Instead of adding cases at the end of the day, Mr. Bernhardt allows surgeons to add additional cases in at the beginning of the day to keep clinical times moving smoothly. This allows staff members to anticipate when they will be leaving the center each day. Also everyone must agree to the meaning of 'Start Time.' Their start time is when the patient enters the OR. "We have three early start rooms, which will normally start at 7:30 am," says Mr. Bernhardt. "Surgeons can add cases before their clinical hours; I oftentimes add a microdiscectomy or a quick arthroscopy in the morning. We can do two cases at 6:30 am and one case at 7 am starting time. The flexibility is in the schedule and not having any gaps during the day, you can allow early cases in the morning to drive additional patient volume." 3. Optimize OR selection. Coordinate ORs so similar cases follow each other. The goal is to minimize the movement of equipment. For example, Main Street Specialty Surgery Center can do all shoulder surgeries in one room and all knee surgeries in another. You can coordinate even further by doing all left side surgeries first before switching to the right side. Another way is to do all the knees in a row and then do the shoulders. "You have to schedule similarities in the operating rooms so things flow smoothly," says Mr. Bernhardt. "We are a multispecialty ASC, so for example we put all the general surgeries in one room and line up hand surgery cases in another. Managing the surgical schedule can create efficiencies every day." 4. Maintain a consistent staff. Build a quality team at the surgery center and maintain the same staff members for as long as possible. Surgeons appreciate working with the same team from year to year, and knowledgeable employees are more efficient and effective than new hires. "We put the same people with the same surgeons 80 percent of the time, and we cross train staff members to back up our team," says Mr. Bernhardt. "They easily shave 10 minutes from each case just because we have a consistent staff." The staffing must also be adequate, which can come at a great expense to the ASC. However, moving patients through efficiently can improve ASC revenue and enhance the bottom line in the long run. 5. Assign float staff for room turnover. In an attempt to run a lean business, many surgery centers charge their regular staff with room turnover. However, with a limited team, turnover times are slower. Instead, ASCs can designate "float" staff to move from room to room and help with turnovers as necessary. "We try to have extra staff members in the hallways so people who were working on the cases in those rooms don't have to come back and turn over their rooms," says Mr. Bernhardt. "The minute the circulating nurse transports the patient, our float staff comes in and cleans the room, and then 9 opens it up for the next case. Our average room turnover is three to six minutes. ASCs try to cut costs and expect the room staff to clean their own rooms, but their turnover times are abysmal." Quick turnover times are crucial, because they are one of the big advantages many surgeons see for surgery centers over hospitals. Mr. Bernhardt also has surgical Jeff Bernhardt techs and support techs available to help with room turnovers because they ensure the equipment is ready for the next case. "Our surgeons want to flip from one room to another if we have extra rooms — they'll do a shoulder and then flip to the knee," says Mr. Bernhardt. "If we aren't running all five operating rooms, we flip rooms. That requires a commitment from the staff to help them do that. It costs a little more to hire these employees, but their help pays for itself." 6. Standardize equipment trays and sterilization. Poorly-managed supplies and equipment lead to increased sterilization time cycles and slow turnaround times. When supplies and equipment are standardized ASCs can move through cases more efficiently. Many surgery centers have just enough trays available to complete a few cases before the sterilization process begins. This slows down the turnovers and may end up costing the ASC more in the long run due to decreased efficiency.