asc management
Our ASC Is Up and Running
We determine the proper staffing level, make our hires, and learn to operate at peak efficiency.
By Larry Patterson, M.D., and Ray Mays

After all of the planning and the slow start in getting our surgery center approved by the state, we finally arrived at the point of recruiting, hiring and training the ASC team. We were fairly certain that our volume would average approximately 15 cataract surgeries per week, about 5 YAGs a week and 1 or 2 other surgeries each week.

We Create Our ASC Staff

Our plan for the ASC called for us to schedule our cataract surgeries all day Tuesday, and to perform other types of procedures throughout the rest of the week. In order to do this we needed a full-time registered nurse (our nurse administrator), a full-time surgical technician, a full-time front office manager, a part-time CRNA, and 2 part-time nurses (RN or LPN).

Our search for a nurse administrator was discussed in a previous article, and we transferred a front office person from our clinic to the ASC. That left us with the search for a "scrub tech." We selected a person who has ended up splitting her time between serving as a scrub tech in the ASC and an ophthalmic tech in the clinic. Our search for part-time nurses was not as difficult as we had anticipated, but the search for a CRNA was (and continues to be) a challenge.

Our goal is to maximize the use of our time on Tuesday. We wanted to develop the most efficient operational model that we could devise, and create a calm, professional environment for the patient.

We determined that 95% of the cataract surgeries that we would be performing would proceed according to the surgical plan, so we built our operational model around that assumption. We would deal with the 5% of cases that wouldn't go according to plan on a case-by-case basis.

Surgery in Seven Steps

A typical case consists of seven steps: (1) scheduling, (2) check-in, (3) pre-op, (4) surgery, (5) post-op, (6) discharge and (7) billing.

By breaking down each of the seven steps into their individual components, we were able to identify and correct problems, eliminate redundancies, and reduce the chance for errors. The exact sequence of events is more detailed than we have space for in this column, but we are able to perform up to 28 cataract surgeries out of one operating room per day. Other procedures consist of the same seven steps, but are scheduled throughout the week. (Dr. Patterson will be speaking on the subject of ASC efficiency at the American Academy of Ophthalmology meeting in Anaheim in November.)

We meet with the staff quarterly to "go over the numbers." We measure key areas such as time from check-in to discharge, recovery time, percent of compliant patients, and patient satisfaction.

After almost 18 months of operation, we're now faced with a surgical volume that may require us to change from one to two cataract surgery days per week. And we're currently going through many of the same decision processes that led us to build an ASC in the first place. Is the volume steady, or is this a spike? Can we support two operating days with current staff, or will we have to recruit more people? How will a change affect our clinic operations and profitability?

Probably the greatest benefit of owning your own ASC is that the answers to these questions don't depend upon anyone else's schedule. Our clinic schedule drives the ASC schedule. We don't have to request "O.R. time" from a hospital or another ASC. We've been fortunate to have been able to put together a wonderful team of professionals who come together each Tuesday and perform at an incredibly high level of skill and efficiency.

Next month, we'll look at purchasing equipment for the ASC.

Larry Patterson, M.D., is practice owner, and Ray Mays is practice administrator of Eye Centers of Tennessee, a general ophthalmology practice serving 300,000 residents of middle and east Tennessee. You can reach Ray Mays at raym@ecotn.com.