Manage schedule closely for steady patient stream
Maximizing the use of your operating or procedure rooms can positively affect your bottom line. Although staff members can reduce turnover time to increase the number of cases each room can handle, what can you do about no-shows on the day of surgery or physicians who don't use all of the time blocked out for their procedures?
Asking patients if they want to be called if an opening occurs in the schedule prior to the date of their scheduled procedure is one way to keep the operating room schedule filled, says John Gleason, administrator for The Berks Center for Digestive Health in Wyomissing, PA. "We have a list of ASAP [as soon as possible] patients who have agreed to move their procedures to an earlier day, and we'll call them when we see an opening," he says. "We can't always fill spots with these patients, but it does work sometimes."
His center has only one practice that uses the center, and the physician's office schedules the procedures. They receive the schedule about five days prior to the procedures. Because the physician's practice has implemented a process that doesn't require patients who are undergoing routine screening colonoscopies with no apparent health problems to see the physician prior to the procedure, it is especially important for Gleason's staff to make a pre-op call two to three days prior to the procedure, he says.
"Although the physician's assistant who screens the patients by telephone and collects medical history information does explain the home preparation for the procedure and sends written information, patients don't always read it or understand it," he explains.
A pre-op call, made prior to the day that patients must begin preparation for the procedure at home, cuts down on the number who must be rescheduled on the day of surgery due to lack of preparation, Gleason says. The call also gives staff members a chance to identify patients who will not show on the day of surgery due to schedule conflicts, illness, or other reasons, he says.
The most critical element in having a patient move the time and day of the procedure is timing because preparation for gastroenterology procedures takes a couple of days, he explains.
The most frustrating issue for surgery centers is not patients who let you know a few days ahead of time that they are canceling or rescheduling, but patients who just don't show on the day of the procedure, Gleason says.
"We routinely have two to three cancellations a day," he says.
Although a no-show is good news for patients who may have arrived early for their own procedure, missed appointments can cause gaps that are not productive for staff members or surgeons, Gleason says. To address this problem, his center is taking a bold step with a new process that is scheduled for implementation this year, he says. "We will overbook the center by scheduling two or three extra patients each day," he says.
When they schedule the patient, they will give the date of the procedure but not the exact time, Gleason says. "We'll explain that we will call with the exact time two to three days prior to the procedure," he says. These patients will be scheduled for times for which the center has learned of cancellations in the pre-op calls, or they'll be assigned times throughout the day, based on the existing schedule, Gleason says. Having the extra patients showing up at different points during the day will fill the gaps caused by no-shows, he points out.
As the idea for this scheduling process has been developed, Gleason obtained buy-in from staff members and physicians, he explains. "It is important that all of the surgeons agreed to handle an extra patient or two if we have overbooked and there are no cancellations," he says. "If there are no cancellations, or only one or two cancellations, the patient is seen as quickly as possible."
Although many surgery centers designate blocks of times for each surgeon and then let the surgeon's office staff schedule the procedures, the staff at Eastside Endoscopy Center in Bellevue, WA, assumes responsibility for all schedules, says Michelle Steele, RN, nurse administrator.
"Each physician has a block of time in the schedule, and we fill the schedule from the earliest time to the latest time," she says. "If a patient cancels, we call the patient with the latest time in the block to move him or her to the time slot of the canceled patient."
By using this approach, Steele can ensure that she doesn't have staff sitting and waiting on the next patient due to gaps in the schedule. She also has the option of sending staff home once all of the cases are complete. "We do occasionally have patients who cannot arrange transportation during certain times of the day and we will accommodate them, even if it means a gap in the schedule," Steele says. "This is not a frequent occurrence."
Physician practice managers also know to call Steele's staff as soon as a physician plans a vacation or time away from the surgery center, she says. "The practice keeps the block of time if there are other physicians in the practice that want to use it," Steele adds. "The practice manager just lets us know which physician is assigned to the extra time."
If it becomes apparent that the physician won't be able to fill the extra time, Steele's staff checks with the practice manager and releases the time to other physicians.
Although managing the operating room schedule requires constant communication with physicians' offices and patients, it is critical to the financial success of any center, Gleason says. "We need to focus on activities that can keep staff members and physicians busy and productive the entire time they are in the center," he says.
Sources
For more information about managing an operating room schedule, contact:
- John Gleason, Administrator, The Berks Center for Digestive Health, Wyomissing, PA. Telephone: (610) 288-3229. E-mail: [email protected].
- Michelle Steele, RN, Nurse Administrator, Eastside Endoscopy Center, Bellevue, WA. Telephone: (425) 451-7335.
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