Amy McKiernan, administrator of Louisville (Ky.) Surgery Center, who runs a multi-specialty ASC with two ORs and seven pre-op/recovery bays, discusses tactics to overcome space constraints in a small ASC.
1. Concentrate on block scheduling. When Ms. McKiernan's center opened, the facility had two plastic surgeons and one physician who performed oculoplastics. Because of the low number of physicians, there were days when no cases were scheduled. When the center added two orthopedic surgeons, Ms. McKiernan had to figure out how to run a full schedule without angering surgeons or staff or spending extra money on overtime. The answer, she says, was block time. "We look really closely at block time and make sure each doctor has a day or two days — one even has three days," she says. "They always have the same days, which helps with staffing and knowing how much staffing to have."
Because different specialties will require different staffing levels, keeping surgeon schedules consistent will help your staff remember when to come in. For example, when Ms. McKiernan's center performs an ENT case, she knows she will need more staff members than when she has a plastics case. Keeping cases consistent will also help your ASC become accustomed to the size constraints of the facility; staff members will know that every Tuesday, for example, they need to make sure to move one patient out of the PACU on time to make room for the next patient.
2. Orient employees arriving from the hospital. If you frequently hire employees who are leaving hospital jobs to join your facility, they may not be used to the ASC environment. ASCs generally enjoy faster turnover times than hospitals, and quick turnaround is especially important in a center with limited space. Nurses may have to learn to depend on other staff for tasks they are used to doing themselves. "In the hospital, you'd come back and make sure everything was perfect and then go get the next patient," Ms. McKiernan says. "At the ASC, you [have to let] the scrub tech take over cleaning up the room while you take over the next patient."
Set up expectations during the initial interview, Ms. McKiernan recommends. "In interviews, I say we work at a much faster pace," she says. "For some people, it's just not meant to be. We've had some people who come from the hospital and just can't move [fast enough], and then the doctor is upset and anesthesia is wondering why they haven't brought the patient back." To make sure employees understand the necessity of quick case turnover, pair new staff members with experienced team members in their first week, she says.
3. Schedule surgeons whose cases complement each other on the same day. If your center performs multiple specialties, try and schedule surgeons who can perform cases at the same time in the ASC without butting heads. Ms. McKiernan's center schedules one of its cosmetic surgeons on the same day as an ENT physician. "One of the plastics guys does cosmetics only, and his cases tend to be longer. That works out if he's paired with an ENT doctor, because the ENT doctor will do 20 cases in a day with a quick turnover," she says. "We don't have to worry about pre-op and recovery for the [cosmetics] room." Talk to your physicians and explain your situation; in Ms. McKiernan's experience, most surgeons are amenable to moving their schedule around if they understand it benefits the center financially.
1. Concentrate on block scheduling. When Ms. McKiernan's center opened, the facility had two plastic surgeons and one physician who performed oculoplastics. Because of the low number of physicians, there were days when no cases were scheduled. When the center added two orthopedic surgeons, Ms. McKiernan had to figure out how to run a full schedule without angering surgeons or staff or spending extra money on overtime. The answer, she says, was block time. "We look really closely at block time and make sure each doctor has a day or two days — one even has three days," she says. "They always have the same days, which helps with staffing and knowing how much staffing to have."
Because different specialties will require different staffing levels, keeping surgeon schedules consistent will help your staff remember when to come in. For example, when Ms. McKiernan's center performs an ENT case, she knows she will need more staff members than when she has a plastics case. Keeping cases consistent will also help your ASC become accustomed to the size constraints of the facility; staff members will know that every Tuesday, for example, they need to make sure to move one patient out of the PACU on time to make room for the next patient.
2. Orient employees arriving from the hospital. If you frequently hire employees who are leaving hospital jobs to join your facility, they may not be used to the ASC environment. ASCs generally enjoy faster turnover times than hospitals, and quick turnaround is especially important in a center with limited space. Nurses may have to learn to depend on other staff for tasks they are used to doing themselves. "In the hospital, you'd come back and make sure everything was perfect and then go get the next patient," Ms. McKiernan says. "At the ASC, you [have to let] the scrub tech take over cleaning up the room while you take over the next patient."
Set up expectations during the initial interview, Ms. McKiernan recommends. "In interviews, I say we work at a much faster pace," she says. "For some people, it's just not meant to be. We've had some people who come from the hospital and just can't move [fast enough], and then the doctor is upset and anesthesia is wondering why they haven't brought the patient back." To make sure employees understand the necessity of quick case turnover, pair new staff members with experienced team members in their first week, she says.
3. Schedule surgeons whose cases complement each other on the same day. If your center performs multiple specialties, try and schedule surgeons who can perform cases at the same time in the ASC without butting heads. Ms. McKiernan's center schedules one of its cosmetic surgeons on the same day as an ENT physician. "One of the plastics guys does cosmetics only, and his cases tend to be longer. That works out if he's paired with an ENT doctor, because the ENT doctor will do 20 cases in a day with a quick turnover," she says. "We don't have to worry about pre-op and recovery for the [cosmetics] room." Talk to your physicians and explain your situation; in Ms. McKiernan's experience, most surgeons are amenable to moving their schedule around if they understand it benefits the center financially.