The most successful surgery centers are incubators for innovation, employing resourcefulness and nimble responses to unexpected challenges. If ever there was a time for pushing the envelope, thinking outside the box, or (insert your favorite well-worn cliché here), it’s 2020. The following tips, pearls, and creative fixes may have been born out of necessity during the coronavirus pandemic, but while some may be temporary, several have proven their worth and will be implemented permanently. You may find a good fit for your surgery center.

Necessary Restriction Had a Silver Lining

“Why didn’t we think of this before?” That was the question making the rounds among her colleagues, says Carrie Jacobs, vice president of operations and administrator at Chu Vision Institute in Bloomington, MN. They were referring to the decision to not allow drivers, family members, or responsible adults inside the surgery center with patients. This prohibition, necessitated by the coronavirus pandemic, created an unexpected opportunity for a more streamlined discharge process.

“Of all the adjustments we had to make because of COVID-19, this one actually made us more efficient,” Jacobs says. “Our discharge time—the time in post-op to taking the patient out of the surgery center—has decreased by about 25% to 30%.”

How did they do it?

Pre-COVID, a responsible adult, usually a family member, accompanied the patient inside the ASC, waited until the surgery was completed, and then was brought back to post-op to be with the patient and receive discharge instructions from a nurse. Now, the nurse, who is with the patient in post-op, calls the responsible adult, who is waiting in the vehicle (and who has submitted the post-op signature in advance), and gives instructions simultaneously to the patient, face-to-face, and the responsible adult, via phone. Another phone call alerts the driver when the patient is ready to go home.

“It’s remarkable,” Jacobs says. “You wouldn’t think that would create such a huge efficiency, but it really does. Between the driver having to go back and forth in the facility plus having to go outside, get the vehicle, and pull it around, those precious minutes add up. In addition, having fewer guests in the building relieves our staff of having to repeat the complex sanitation processes that are now required as people come and go.”

It’s too soon to predict life after COVID-19, Jacobs says, but this change in procedure may become permanent.

Reimagined Spaces Maintained Pre-COVID Volume

With COVID-19 restrictions preempting many of the guidelines that ASCs are accustomed to following, including how a facility is set up, many surgeons and staff are viewing their spaces with critical eyes.

“One thing we learned with COVID-19 is to redefine the space inside the ASC,” says Denise M. Visco, MD, MBA, medical director and founder of Eyes of York and a partner in Eyes of York Cataract & Laser Center in Pennsylvania.

“For example, now that we don’t have family coming in to the surgery center with patients, we essentially don’t have a waiting room,” Dr. Visco says. “So we incorporated that space into our PACU workflow.”

Of course, this new arrangement was easier said than done. Pre-COVID, the PACU had five beds and two chairs; physical distancing requirements would have reduced that number to three beds and no chairs. “The difference between having three slots and five slots in your PACU is enormous, as it relates to the number of surgeries we can perform per day,” Dr. Visco says. “So we emptied the waiting room and the PACU and thought literally outside the box.”

Reimagining their space and rearranging the furniture, Dr. Visco’s team was able to keep five beds in the PACU with the appropriate space between them, even though they were slightly askew in the bays. They moved the two chairs to the waiting area, which is now a surgery staging area, where patients’ assessments are completed and eye drops are given.

“We actually have more capacity with this arrangement, and patients spend less time in the PACU than they did before, because we’re performing several of the surgery prep tasks in the waiting area,” Dr. Visco says. “We can process the same number of patients in a day as we did pre-COVID, but more safely and in keeping with all of the protocols and procedures for COVID.”

Dr. Visco notes surgical volume was reduced while everyone became comfortable with the new routine, but after about 6 weeks, volume was back to normal. “Re-arranging our physical space was the least expensive and most proliferative thing we did to adapt to the COVID restrictions.”

As for the new arrangement, says Dr. Visco, “We’ll keep it until we don’t need it anymore. When it’s time to use the waiting room again, and nobody’s worried about COVID, we’ll go back to what we were doing before.”

Same-Day Post-Op Exams Freed Up Next-Day Clinic Time

“The concept of same-day postoperative examinations, although not new, may not be widely used, but that’s changing in my practice,” says Lisa K. Feulner, MD, PhD, founder of Advanced Eye Care & Aesthetics in Bel Air, MD.

“I started doing post-op exams in the office on the day of surgery to eliminate the non-revenue-generating appointments the next morning,” says Dr. Feulner. “As a result, I really saw a jump in practice revenue. We freed up almost 3 hours of clinic time the following day, which meant I could see 20 to 30 extra patients.”

Dr. Feulner switched to same-day post-op exams in the middle of June, and the increased revenue was already notable in July. “Even though the longer surgery days are tiring, and I miss seeing how excited my cataract patients are about their vision at the 1-day visit, I definitely plan to continue with same-day post-op exams after the pandemic,” she says.

Sourcing PPE

The availability of personal protective equipment (PPE) varies greatly from region to region, and shopping at Home Depot, Amazon, and similar stores is not uncommon.

“One of our biggest challenges right now is not a lack of patients—patients want to have their vision fixed—it’s trying to source and conserve PPE,” Jacobs says. “Managing the supply chain and our inventory of PPE has taken on a whole new meaning. We have to be very resourceful.”

For example, in August, Jacobs was rationing surgical masks, doling them out to the ASC team every morning, because the masks were back-ordered, possibly until November.

“I think the safest approach now for ASCs that are experiencing this shortage is to keep track of what’s available from vendors on a daily basis, because what’s there today may not be there tomorrow,” says Jacobs. “Having a dedicated staff member who’s constantly overseeing inventory is critical right now when the availability of protection supplies is so fluid and changing daily.”

Dr. Visco reports that suppliers are rationing PPE for her surgery center in York, PA. “It’s concerning,” she says. “Everybody wants to stock up on PPE, because if you run out of it, you can’t operate. But the suppliers don’t allow us to purchase more than the amount we’re rationed.”

Dr. Feulner, who operates in an ASC near her practice in Maryland, says there were shortages of PPE early in the pandemic until the county health department stepped in. “Our county provides healthcare workers with a steady supply of N-95 masks and as much PPE as they can offer us, along with gloves, shoe coverings, bouffants, and nonsterile gowns,” she says.

Parting Thoughts

Making up for revenue lost during the pandemic shutdown is on everyone’s mind, but according to Dr. Visco, “It’s difficult for a surgery center to look at things like premium lenses, elective surgeries, and pass-through medications as significant revenue streams, because their use is driven by the surgeon. As a surgeon, my motivation is to do what’s best for my patients. If something is good for the patient, it will be good for the practice and, of course, your reputation in the community.”

Dr. Visco says she and her partner will be scrutinizing expenses in the wake of the pandemic, and some capital expenditures may be postponed or abandoned.

However, Dr. Visco notes, “In my opinion, the best way to increase revenue in your facility post-COVID is to figure out how to increase your throughput.” ■