Teamwork and anesthetics reduce surgery times
Benchmarking identifies areas of improvement
If you perform knee arthroscopy with meniscectomy in your program, you might wonder how you compare with others in turnaround times, discharge times, supply costs, and staffing for the procedure.
Participants in the Performance Management Study of Knee Arthroscopy with Meniscectomy not only have the information, they have used it to make changes in their practices. The study was conducted by the Institute for Quality Improvement, a division of the Association for the Accreditation of Ambulatory Health Care in Wilmette, IL.
There are many reasons to participate in national benchmarking studies: to collect data for your own quality assurance program, find ways to improve your service, become more cost-effective, and meet accreditation requirements.
"Our primary reason for participating was to satisfy requirements for accreditation and to see how we could improve our service," says Ken Summerhays, RN, CNOR, director of nursing at St. George (UT) Surgical Center.
While Summerhays says many results did not surprise him, his ranking as second shortest turnover time reported for this procedure did shock him. St. George’s turnover time for knee arthroscopy was 20 minutes in a category that ranged from just under 20 minutes to almost 90 minutes with a median time of 32 minutes.
"We have always used teamwork to set up and clean up for each procedure, and we just take the things we do for granted," he says.
One area in which the St. George center did not do as well was discharge time, but Summerhays says he was not surprised. With a discharge time of about 110 minutes in a category that ranged from less than 20 to almost 160, he says that the average time reflects the practice of the anesthesiologists. "We have one anesthesiologist in the group who routinely uses shorter-acting anesthetics that are ideal for same-day surgery, but the other anesthesiologists are more accustomed to traditional, hospital-based operating rooms, so they tend to use anesthetics that require longer recovery time," he explains.
While it is hard to change a physician’s practice, the results have been shared with the anesthesia director to provide support for a proposal that will have one or two anesthesiologists who specialize in same-day surgery designated as the physicians for the surgery center rather than rotating the entire anesthesia group through the same-day surgery center, he says.
Not all participants focused on the results that looked at pre-op time, on-time starts, procedure times, turnaround, and discharge times.
"We are a solo-practice, office-based surgery center that may only do two or three procedures a day, so times are not as critical to us," says Dick Farr, OPA-C, clinical manager at Magnolia Arthroscopy and Hand Day Surgery in Statesboro, GA. "I was most interested in seeing supply costs and use of local sedation."
While the study does show that number of procedures doesn’t necessarily affect start times, turnover times, procedure times, and discharge times, Farr says he noticed a significant difference in supply costs between his program and other programs that purchase a larger volume of supplies. The Statesboro program ranked second highest on the cost of pump tubing and highest for shaver blades.
"We only perform 22 knee arthroscopies in the office surgery center each year, so we are not buying quantities that qualify us for big discounts, but I am using this information to talk with our vendors to negotiate better prices," says Farr.
Study participants’ costs for pump tubing ranged from $25 to over $100, with the median cost at $53. Costs for shaver blades ranged from just under $50 to about $175, with the median cost at $140.
Because Farr’s program does not administer general anesthesia in the office-based surgery setting, he was interested in seeing how many other participants used monitored anesthesia care that involved local anesthetic along with IV sedation. "Local anesthetics did result in patients recovering as much as 45 minutes sooner than general anesthesia," he points out.
Only 11% of the study participants reported use of monitored anesthesia, and 76% indicated they use general anesthesia. Other types of anesthesia techniques were epidural, spinal, and femoral block.
One of the best aspects of sharing his center’s results with his staff was the morale boost, says Summerhays. "Everyone was proud to see that the categories that were directly staff-related [as opposed to surgeon- or anesthesiologist-related] were categories in which we excelled."
For more information about the use of benchmarking study information, contact:
• Ken Summerhays, RN, CNOR, Director of Nursing, St. George Surgical Center, 676 S. Bluff St., St. George, UT 84770. Telephone: (435) 673-8080. Fax: (435) 673-0096. E-mail: [email protected].
• Dick Farr, OPA-C, Clinical Manager, Magnolia Arthroscopy and Hand Day Surgery, P.O. 328, Statesboro, GA 30459. Telephone: (912) 764-6322. Fax: (912) 764-2887.
Copies of the knee arthroscopy with meniscectomy study are priced at $50 each and can be paid for by check or major credit card. To order a copy of the study, or to find out about upcoming benchmarking studies, contact:
• Accreditation Association for Ambulatory Health Care, Institute for Quality Improvement, 3201 Old Glenview Road, Suite 300, Wilmette, IL 60091-2992. Telephone: (847) 853-6060. Fax: (847) 853-9028. Web site: www.aaahciqi.org.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content