Dawn Q. McLane, RN, MSA, CASC, CNOR, is regional vice president of operations for Health Inventures.
Q: What is a good benchmark for maximum operating room utilization in an ambulatory surgery center and what are some of the ways we can achieve this?
Dawn McLane: We usually try to shoot for at least 75-80 percent utilization. The higher the better, but with turnover time and functions that have to be performed in the room that don't involve actually doing a case (like cleaning and moving equipment), there has to be some down time in the OR between cases.
Generally when we're building ASCs a de novo project, we're looking at case mix and what types of cases are going to be performed there. We want to know what types of specialties and what types of procedures within those specialties. Eyes and GI, for instance, are typically quicker, while some plastics can be 3-4 hour cases. It's important to know who your surgeons are going to be, how they operate. One surgeon might perform three knee scopes in an hour, for example, and another might do one or two.
It really comes down to what types of specialties you're going to perform in that center and then knowing your physicians who are going to be working there and how they like to work.
Another thing that can affect the number of cases in an OR is how you're doing your blocks if you're highly orthopedic. With more and more regional blocks being done for shoulder and knee cases, consideration should be given to where those blocks are being performed. Are they performed in the pre-op area or are they doing them in the OR? If they're doing them in the OR, that can cause the case time to be longer. To perform them in pre-op, an anesthesia provider must be available while the prior case is being performed, or he or she must perform the block during the turnover time between cases. In some centers, the anesthesia provider may be blocking the patient two cases ahead instead of immediately before the case.
The whole process of how the case is carried out, what types of anesthesia are being given and where the anesthesia is being administered can elongate the case times.
Scheduling can certainly impact the number of cases you're doing in the OR. New centers will sometimes intentionally keep rooms open even though they don't have them filled because they're in ramp-up, trying to fill them and the only way they can do it is to make sure the time is available so the surgeons can get on the schedule as the practice changes patterns. But you can't survive for very long when you have a lot of holes in your schedule. In order to improve utilization, you have to close those gaps eventually.
A few additional cases scheduled into the gaps can make an amazing difference in the efficiency of the center and a positive impact on benchmarking indicators like hours per case.
Another aspect to consider is when you release your block time to open scheduling, if you're block scheduling like most ASCs do. I've been in centers that do it anywhere from 24 hours to a week in advance. If they haven't filled a block, the block releases and it becomes open time and anyone can schedule into it. That's one way to fill those gaps. The more mature the center, the more they recognize and work to manage the volume they have and to close those gaps.
It's good to try to have at least one open block available all of the time — every morning and every afternoon. Make sure there's one time available for surgeons who can't get on the schedule because they may not be busy enough to have their own block but they do have cases they want to bring. Then release the designated blocks as early possible to make them available to these surgeons who don't have blocks.
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Read more from the leadership of Health Inventures:
- How to Know When to Expand a Surgery Center: Q&A With Dawn Q. McLane of Health Inventures
- 4 Ways Surgeons Can Increase Surgery Center Distributions
- 5 Ways Anesthesia Providers Can Improve Patient Safety