Building Efficiencies into the Operating Room Part 1

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Building Efficiencies into the Operating Room
Part 1
Robert J Cionni MD Medical Director CEI
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Efficiency

• Speed alone does not equal efficiency
• Definition
• 1. The quality of being efficient competency in
  performance.
• 2. Accomplishment of a job with a minimum
  expenditure of time and effort.

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ASC Efficiency

• Pre-operative steps to improve ASC efficiencies
  Dr Cionni
• Peri-operative steps to improve ASC
  efficienciesDr Patterson

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CEI Background

• 100,000 sq ft facility
• Clinic, administration, laser center, 33,000 sq
  ft 6 OR ASC
• 10,000 procedures/yr (not including laser
  refractive.
• Cataract, glaucoma, oculoplastics,
• Large facility must run efficiently

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What Pre-op Factors affect Efficiency?

• Case preparedness
• Scheduling
• Pt education/understanding
• Nurse/Tech/Anesthesia factors
• Surgeon Factors

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Case Preparedness

• Goal
• 1) Avoid errors
• 2) Avoid surprises that cause case delay or
  cancellation
• Key to case preparedness is the Op plan

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Op Plan

• Op plan constructed on the consult day
• Patient is fresh in your mind
• Helps scheduler schedule appropriately, educate
  patient properly
• Gives OR advanced notification as to what is
  needed for the case
• Better assures IOL and other items which may be
  needed will be in stock and pulled for case

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Op Plan Example
Chart available to review in OR
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Scheduling

• Surgery coordinator schedules surgery based on
  the surgeons Op Plan
• Surgeon must be realistic as to time needed for
  case
• Schedule like-procedures together
• Keeps OR in the same mindset
• Schedule longer cases at end of schedule
• Less likely to cause many to wait
• First and second post-op visits scheduled at same
  time as surgery date and time

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Patient Education

• Goal is to ensure patient understanding of
• PARs
• Lens choice
• Pre-op patient responsibilities
• Day of surgery process
• Patient confusion can lead to cancellation,
  delays, frustration, errors, etc

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Patient EducationSurgery Coordinator is Key

• Surgery coordinator confirms with the patient the
  correct eye, procedure and IOL style
• ABN is signed for out of pocket premium IOL
  expenses if indicated
• Informed consent is reviewed with patient and
  signed
• Surgery date and time confirmed with pt

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Patient Education

• Surgery Coordinator reviews with the patient and
  family member the items that are patient
  responsibility (verbal and printed review)
• need for H P
• NPO policy
• Eye meds to take pre-op and systemic meds to take
  
• Need to arrive ON TIME and have a driver with
  them day of surgery
• ASC nurse calls to confirm all of the above 1 day
  before surgery!

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Patient Education

• If there exist any significant physical
  conditions such as a pacemaker Marfans
  obesity or any cases scheduled for general
  anesthesia, the surgery coordinator contacts PAT
  dept and request an RN from PAT assess the
  patient same day or at least one week before
  surgery

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PATs RoleAssure patient safety and avoid same
day cancellations

• May assess higher-risk pts on day of office visit
  and determine if anesthesia personnel need to see
  pt
• Call all patients 1 week before surgery
• Assess medical hx and meds
• Confirm needed pre-op testing is obtained before
  pt arrives
• Follow-up chart to confirm needed info has
  arrived and give to Anesthesia for review

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Nurse/Tech/Anesthesia Factors

• The more experienced and knowledgeable, the
  smoother the case
• At least one experienced person in room
• Nurses/techs can premark when needed
• Stretcher/microscope/footpedal/ stool positioning
  
• Anesthesia team must be on board
• Monitoring RN helpful to free-up anesthesia
  personnel to next case

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Surgeon Factors

• Be on time!!!
• Starting late causes rushing from the very onset
• Keep on task
• Be polite
• Eases tension
• Lowers personnel turnover
• Move to topical anesthesia

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Thank You!