Kaiser shares ambulatory surgery benchmarks
5 process improvements that get results
As ambulatory surgery programs have an increasing number of more intense cases and higher acuity patients, they are finding that surgeries take longer to perform. What can you do to improve your program’s efficiency but still maintain quality of care?
After a study of best practices within the hospitals and utilization in the main operating rooms and ambulatory surgery units, administrators at the Pasadena-based Kaiser Foundation Hospitals of Southern California suggest using these benchmarks to compare your performance with that of your peers. (For more benchmarking sources, see list, inserted in this issue.)
• Block utilization: 85% in main OR; 80% in ambulatory surgery unit.
Block utilization refers to the percentage of time the ORs are being used measured against the amount of time allocated within a specified time frame. Ambulatory surgery units have lower utilization because of their specified hours of service, says Inez Tenzer, RN, MS, CNOR, CNAA, assistant director of divisional nursing at Kaiser California Division in Pasadena.
Improving utilization is key
"Probably your biggest bang for the buck, unless your turnaround is off the wall, is improving utilization because of the high dollars in surgery: the surgeon, anesthesiology, staff, materials, and time in the OR," Tenzer says. "If you can improve utilization, that’s where the cost benefit comes in, and you have more control over that in the way you schedule."
• Room turnaround: 21 minutes in main OR; 15 minutes in ambulatory surgery unit.
• Surgeon turnaround: 58 minutes in main OR; 42 minutes in ambulatory surgery unit.
These figures were averages, not benchmarks, Tenzer emphasizes. "Turnaround time is a nemesis for the OR manager. It receives so much emphasis." The focus should be on getting the maximum advantage of the energy you spend reducing cost and increasing efficiency, she says.
Determine what you’re going to gain by improving your turnaround time, she suggests. "The problem is that for the amount of energy you put into trying to improve your turnaround time, you don’t usually gain a whole lot, unless the turnaround time is off the wall. If you improve a couple of minutes, at the end of the day, what does that buy you? Do you move cases along faster? Prevent overtime? Put another case in? In the majority of facilities, probably not. The only thing it probably does is give people a better feeling of people working harder, better, and more efficiently."
5 tips for improving performance
So what can you do to improve your performance? Consider these suggestions:
• Use block scheduling.
Kaiser Foundation Hospital, San Diego, has a three-room ambulatory surgery center in El Cajon that offers block scheduling in segments of about four hours, from 7:45 a.m. to noon and 12:30 p.m. to 5 p.m.
"Our surgical time is basically accounted for on a regular basis," says Shirley Helsel, RN, department administrator for perioperative services. "We’ve discovered by running two of the rooms through lunch time, we can increase the number of cases significantly without adding additional staffing. We added at least three to four cases a day."
Previously, the staff took a lunch break from noon until about 12:45 p.m. "Even with half an hour lunch break, you have to account for setup and cleanup," Helsel says.
Now, the staff on the 11 a.m. to 5:30 p.m. shift provide lunch relief in the rooms. The center doesn’t run the third room during lunch 100% of the time because it would require additional staff. Additional staff are scheduled 3 p.m. to 7 p.m. "After cases, they clean up and set up for the next morning so the facility is ready for start time at 7 a.m.," she says.
Physicians report high satisfaction with the surgery center arrangement. "It’s easy to get in and out," Helsel says.
Block scheduling doesn’t work for everyone, however, Tenzer warns. "Do it for selected physicians. Not all doctors feel they can work all day."
• Batch surgeries by type and size.
Consider performing similar procedures one after another, Tenzer suggests. All cataract procedures on the left eye could be batched, for example, and then procedures could be performed on right eyes. "You have to move the equipment around, but just once instead of back and forth," she says.
• Standardize instrumentation as well as supplies.
At Kaiser in San Diego, physicians essentially use the same setups of packs and linens, Helsel explains. "It helps to make it more efficient because the staff isn’t trying to figure out from day to day what they need to pull. There’s a few idiosyncrasies by physicians, but they’re minimal."
Equipment also is typically standardized, Helsel says. If something goes wrong during an endoscopic procedure, a second tower is pulled in. "We plug in, and we’re ready to go again."
• Reduce cost of anesthesia staffing.
Kaiser in San Diego staffs its rooms with certified registered nurse anesthetists who are under the supervision of one physician. The rooms essentially are staffed for 10 hours, but the physician is available until the last patient leaves the facility.
• Use on-site central supply reprocessing.
On-site central supply reprocessing means equipment can be reprocessed, sterilized, and reused on the same day at Kaiser in San Diego. "It makes turnaround time much more efficient and shorter," Helsel says.
[Editor’s note: For more information on improving performance in same-day surgery, contact Shirley Helsel, RN, Department Administrator for Perioperat-ive Services, Kaiser Foundation Hospital, 4647 Zion Ave., San Diego, CA 92120. Telephone: (619) 528-5468. Inez Tenzer, RN, MS, CNOR, CNAA, Assistant Director of Divisional Nursing, Kaiser California Division, 393 E. Walnut St., Pasadena, CA 91188. Telephone: (818) 405-5153. Fax: (818) 405-6412. E-mail: [email protected].]
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