Study looks at time, staff, and costs
The use of more than one operating room per surgeon may increase a physician’s productivity, decrease the number of hours the same-day surgery program needs to remain open during the day, or enable a surgeon to schedule more cases during the day. But how does the additional operating room affect pre-procedure, procedure, turnover, and discharge times?
This is one of the areas examined by the third Cataract Extraction with Lens Implantation Study by the Wilmette, IL-based Accreditation Association for Ambulatory Health Care’s Institute for Quality Improvement (IQI). In addition to studying times, costs, and practices for all 57 participants, IQI presented a section that focused on times and costs of the 34 organizations that use more than one operating room per physician.
In almost all categories, average time for same-day surgery programs using multiple operating rooms per surgeon were one to three minutes lower than same-day surgery programs using one operating room per surgeon, but reported turnover times were higher. Researchers suggest that the average turnover time of 17 minutes for multiple operating rooms vs. 13 minutes for single operating rooms may not be a "true" turnover time because the need for speedy setup and cleanup is not as critical when a single surgeon uses multiple operating rooms.
Using two operating rooms for one surgeon works well, says Paula M. Dobberstein, RN, director of nursing at Surgicare Center in Fort Myers, FL. Her program’s turnover time was fewer than five minutes, but her surgeons also posted the lowest procedure time at seven minutes, so a quick turnover, even with multiple rooms, is necessary, she says.
A total of six employees are needed to staff the two operating rooms, Dobberstein says. "Two RNs, two scrub techs, one person to keep the autoclaves running, and one person to handle patient preparation and transportation are necessary for the operating rooms," she explains. Even though each employee has a primary responsibility, everyone is cross-trained to other areas for times when a staff member is ill or on vacation, she adds.
Organization and teamwork are the keys to low procedure, turnover, and discharge times, says Jennifer Hunter, RN, BSN, administrator and director of nursing at Muncie (IN) Cataract and Laser Center. "We have two operating rooms, but only one surgeon, so we know exactly what is needed during the procedure," she says. "We make sure both rooms are stocked well, with additional supplies pulled ahead of time," she adds.
She was surprised to see that other programs don’t have patients arrive as early as the 90 minutes prior to surgery required by her program, Hunter says. "I am going to take a look at our policy, but may not change it because we tend to run ahead of schedule," she explains. "We can easily take the patient into the operating room earlier than planned if they are here and prepped."
Only 14 of the study participants instructed patients to arrive more than 60 minutes prior to scheduled surgery, and five participants require arrival only 30 minutes prior to surgery.
Ten percent of the patients at Minnesota Eye Laser and Surgery Center in Bloomington are moved ahead in the surgery schedule, says Peggy A. Halvorson, RN, CNOR, nurse manager of the center. Although patients are asked to arrive one hour before their scheduled procedure, pre-procedure time for the center is close to 40 minutes. Thus, patients are ready for the operating room when there are cancellations or when the surgeon is running ahead of schedule, she says.
"We do have one surgeon who is very fast, so we ask her patients to come in 75 minutes prior to their procedure because we know the surgeon will be ready for them sooner," she adds.
The center has one operating room, and the same surgeon uses the room all day, with different surgeons each day, says Halvorson. Because of increasing volumes, the addition of a second operating room has been considered, she says. "It probably isn’t possible because of space constraints, additional equipment needed, and the extra three people I’d have to hire," she says. "Our recovery room can only handle two people, so we’d have to increase it as well."
The IQI study did ask participants to estimate the associated costs of a second operating room for one surgeon, but not all organizations supplied the information. Of the 23 organizations that did, the range of additional personnel time per procedure to maintain more than one operating room per physician was five minutes to 240 minutes, with the median time at 20 minutes.
Of the 10 same-day surgery programs that estimated the additional equipment and supply cost per procedure, the range was $18 to $600, with a median of $131. The costs can be worthwhile for some programs, Dobberstein suggests. The greatest benefit of multiple operating rooms is physician satisfaction, she says. "The surgeons move from one room to another with no delay or downtime, and productive surgeons are happy surgeons."
Resources
For more about the cataract study, contact:
• Paula M. Dobberstein, RN, Director of Nursing, Surgicare Center, 4101 Evans Ave., Fort Myers, FL 33901. Telephone: (941) 939-3456. Fax: (941) 939-1164.
• Jennifer Hunter, RN, BSN, Administrator and Director of Nursing, Muncie Cataract and Laser Center, 3300 W. Purdue Ave., Muncie, IN 47304. Telephone: (765) 289-8251. Fax: (765) 289-8250.
• Peggy A. Halvorson, RN, CNOR, Nurse Manager, Minnesota Eye Laser and Surgery Center, 9117 Lyndale Ave., Bloomington, MN 55420. Telephone: (952) 885-2466. Fax: (952) 884-2656. E-mail: [email protected].
To order a copy of the 2001 Cataract Extraction with Lens Implantation Study, contact: The Institute for Quality Improvement, Accreditation Association for Ambulatory Health Care, 3201 Old Glenview Road, Suite 300 Wilmette, IL 60091. Telephone: (847) 853-6060. Fax: (847) 853-9028. Web: www.aaahciqi.org. Copies of the study are available for $50 plus $12 shipping charge for one copy.
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