Don't lose money! Put spotlight on pre-op
Don't lose money! Put spotlight on pre-op
Drag out your preoperative process, and you risk losing money and patients. In addition, delays may aggravate patients' family members and friends.
To improve their pre-op processes, same-day surgery managers around the country are comparing notes. Their successes are significant: One OR reduced its median OR delay from 76 minutes to 20 minutes. In fact, at one point, before an anesthesiologist's position became open, the median delay at Sewickley (PA) Valley Hospital was reduced to just nine minutes.
Here are ideas you can adopt for your own pre-op process:
* Use beepers and portable telephones for staff.
Previously at Sewickley, nurses were constantly searching for nurse assistants who didn't cross lines between the outpatient pre-op area, OR, and PACU. Under the new system, nurse assistants work in all those areas and are beeped when they are needed.
"They can look at the extension and know where to report without picking up the call," says Marilyn Rudolph, RN, nurse manager of outpatient surgery and the gastrointestinal lab at Sewickley. "We're able to tap into five people [in each area] instead of one."
The pre-op holding nurse previously sat in a holding area with patients whose start times were delayed. Now, that room is used for true preoperative patient needs, such as administering preoperative sedation and monitoring patients. And the pre-op nurse, equipped with a portable phone, moves with patients through the outpatient surgery area, OR, and PACU, which facilitates patient flow.
Don't separate patients too early
* Keep a family member or friend with the patient for as long as possible, and keep that person abreast of the patient's status.
At Beth Israel Deaconess Medical Center in Boston, one family member or friend is allowed to stay with each patient until the staff starts an IV, according to Elena Canacari , RN, CNOR, project manager for ambulatory surgery in the Clinical Center. At that point, the significant other checks in at a concierge desk. He or she is offered a vibrating beeper that allows them to leave the area and be informed when surgery is complete.
Previously, family members and friends weren't aware of when the surgery started. For that reason, they began to question staff when they were separated from the patient for just more than an hour. Now, because the staff keep separation time to a minimum and inform the family members and friends of the patient's status, the significant others tend to become less anxious.
* Cross train personnel to work in different areas.
Previously At Sewickley Valley, staff would wait for nurses' aides to be available to transport patients. To address that problem, the hospital trained all the staff, including RNs, anesthesiologists, and even secretaries, on how to transport a patient to the OR. "Anybody can push a bed," Rudolph says.
Also, under the previous system, nurse assistants in the OR never went to outpatient surgery to make beds, discharge patients, clean rooms, etc. "Now those are everyday tasks," Rudolph says. "We identified that our system is really a perioperative system, not outpatient surgery, PACU, OR, and anesthesia. We're one family."
* Use custom packs and just-in-time delivery of supplies.
To improve its pre-op efficiency, Beth Israel put a satellite central processing department on the same floor as ambulatory surgery, which paved the way for just-in-time delivery of case supplies. "Everything gets delivered to central processing the day before surgery, which is cost-efficient," Canacari says.
The hospital also uses custom packs from manufacturers. "What that means, from an efficiency point of view in the OR, is that instead of opening 18 separate items and putting on a sterile field, we open one package," Canacari says.
* Use a database to accurately schedule ORs.
"This is where we got our biggest bang for our buck," Rudolph says.
Surgeons may say they could perform a procedure in 20 minutes. Rudolph says. "We say, 'We know it takes you 60 minutes. We're putting down 60 minutes, plus 10 minutes of turnover and 20 minutes of prep time.'"
The hospital maintains a database of each surgeon's surgical times. "We pull out of our computer the last 10 times, throw out the high and low time, and look at the average left," Rudolph says.
Endoscopy columns help efficiency
* Avoid moving equipment.
Beth Israel installed endoscopy columns in each OR when it renovated its ambulatory surgery area. "By doing that, we don't have to push the equipment room to room, go over video cables, and break them," Canacari says. "It helps the equipment stay in good condition and is very efficient."
* Stagger your start times and develop a uniform definition of start time.
Sewickley previously gave every same-day surgery patient a 7:30 a.m. start time. By staggering the start times, the anesthesiologists' time is used more efficiently, says Marcia Cifrulak, RN, OR staff nurse. "Also, our start time became our incision time," Cifrulak says.
* Avoid continually rechecking patient charts.
Previously in outpatient surgery at Sewickley, nurses would check charts for informed consent, lab work, etc. Then the charts went to the pre-op holding area where nurses checked the same information. Then in the OR, the circulator and nurse anesthetist checked the charts again.
Virtually 100% of the information is in order, Rudolph says. "So don't waste your time looking at things you don't need to look at," she says. For example, the OR circulating nurses now only look at items they are required to look at, such as informed consent.
"It's a matter of trusting the person before us," Rudolph says. *
For more information on improving the efficiency of the preoperative process, contact:
* Elena Canacari , Project Manager for Ambulatory Surgery, Clinical Center, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215. Telephone: (617) 667-7656. Fax: (617) 667-0123.
* Marcia Cifrulak, 114 William Penn Circle, Sewickley, PA 15143. Telephone: (412) 749-7530.
* Marilyn Rudolph, Nurse Manager of Outpatient Surgery and Gastrointestinal Lab, Sewickley Valley Hospital, 720 Blackburn Road, Sewickley, PA 15143. Telephone: (412) 749-7136. Fax: (412) 749-7308.
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