After a months-long trial, so to speak, COVID-19 protocols have been fine-tuned to function well in the already highly efficient ASC environment. While some of the modifications to physical space and patient flow may be temporary, others will become standard procedures.

Read on for a glimpse at what the “new normal” looks like in some surgery centers and some tips on staying current with the latest best practices in ASCs.

Empty Waiting Areas

“One of the first new procedures we implemented when we reopened, from an infection control and exposure standpoint, is that we no longer allow any responsible adults, a.k.a. drivers, to join patients in our facility,” says Carrie Jacobs, COE, vice president of operations and administrator at Chu Vision Institute in Bloomington, MN. “Right away, that reduced the number of individuals coming in and out of the building. Of course, we make exceptions for anyone with a medical need to remain inside the building, but if they’re able to wait in their vehicle, that is preferable.”

Now that this procedure has been in effect for months, it has been streamlined for efficiency.

“Drivers wait in their vehicles in assigned parking spaces, so we know exactly where to find them if we’re having trouble reaching them,” Jacobs explains. “At the end of the surgery, the surgeon calls the driver to report that the surgery went well. So there’s the surgeon touch. Then the discharge nurse calls the driver to review the discharge instructions and then instructs the driver to pull around to pick up their loved one.”

In addition to mitigating lengthy exposures, as directed by the CDC, Jacobs says this procedure has improved efficiency in the ASC, eliminating the need for staff members to escort people in and out of the building.

At-Home Dilation

The challenge for surgery centers during the pandemic has been to employ rigorous new protocols to minimize exposure times within the facility while maintaining a safe, sterile environment, all without needing to reduce overall volume. Some cataract surgeons have been able to assist in this endeavor and save as much as 20 minutes of pre-op time by having their patients “self-dilate.”

Jacobs explains: “Patients are given a prescription for dilating drops at the surgeon’s office and instructed to instill the drops at home about an hour before their scheduled arrival time. The ASC staff may need to boost dilation in pre-op, but even if patients instill one or two sets of drops just to start dilation, it increases our efficiency.

“So much time is spent waiting for dilation to take place that having patients start that process at home reduces their time in pre-op and gets them in and out of the surgery center much more quickly.”

Curtains Be Gone

Replacing fabric privacy screens with hard-surface dividers has made sanitizing between patients fast and efficient at Chu Vision Institute.

“During the time we were shut down, we replaced the curtain separators between pre- and post-op with portable medical grade vinyl dividers, creating barriers that we could keep sanitized,” Jacobs says. “Between patients, our team wipes down the dividers completely, and at the end of the day, they’re sanitized, accordion-folded, and tucked against the wall. Overall, this was a minimal expense in the grand scheme of things, enabling us to not only follow CDC guidance for infection control but to actually take it up a notch.”

Run Lean, But Not Too Lean

Investing in cross-training is always important, Jacobs says, but even more so during the current public health crisis.

“The risk of contact exposure can increase significantly during a surge of COVID-19 cases, and all of a sudden, a nurse or a technician may need to quarantine at home,” she says. “There’s nothing worse than having someone call out and no one is able to step into that position.

“If it’s feasible within the facility, it’s definitely worth the investment to have a nurse who’s trained in pre-op who can swing into post-op if necessary, or a circulating nurse who also knows how to scrub in for surgery.

“As an ASC, we tend to run lean, but I recommend not running too lean,” Jacobs says. “Investing in cross-training and focusing on the success of the team’s ability to fill in for each other is really important.”

Share Best Practices

During the ever-changing landscape of a pandemic, some of the best innovations have come from collaboration, and that holds true for ASC owners, administrators, and staff.

“During that time—for us, it was March through May—we took the opportunity to investigate how we wanted to look coming back from the shutdown and how we wanted to protect our patients,” Jacobs says. “There were a lot of conversations with colleagues, sharing of best practices, and discussions about how we were going to reopen. We also tapped into organizations, such as the Ambulatory Surgery Center Association and the Outpatient Ophthalmic Surgery Society. Staying connected with your peers and learning what other facilities are doing helps you know if you’re on the right track.”

Now that the surgery center is open and running at near capacity, finding the time to stay abreast of new developments and to mine new ideas for efficiency could be a challenge. According to Jacobs, it shouldn’t be.

“Don’t underestimate the power of connection, even doing a daily morning huddle and then an after-surgery check-in or a weekly in-service,” she says. “It doesn’t have to be long, but making it a focus and a priority is the way you win the game.” ■

LIGHT-EN THE LOAD (HIRE A ROBOT!)

With the threat of exposure to the corona-virus looming, Ahad Mahootchi, MD, decided to take disinfection to the next level at The Eye Clinic of Florida by installing upper-air UV light disinfection units throughout his facility (Figure 1).

“The state has strict requirements on how fast the air has to turn over in an ambulatory surgery center, but once you add UV light, it seriously cuts down on the number of pathogens in the air,” Dr. Mahootchi says, noting the American Society of Heating, Refrigerating and Air-Conditioning Engineers recommends UV disinfection to mitigate the coronavirus.

“We targeted light placement in staff lounges, in particular. That was the weak link in infection control, because that’s where staff members are likely to remove their masks to eat. Now we have some UV help there,” he explains.

The wall units, which cost about $700 each, are about the size of two tissue boxes and can be hardwired by an electrician or plugged into an outlet.

After further research into the efficacy of UV light technology for surface disinfection in the healthcare setting, Dr. Mahootchi invested in a UV disinfection robot.

“Terminal cleaning in the OR is time-consuming and labor-intensive,” Dr. Mahootchi says. “Now, we just wheel in this little R2-D2-looking robot (Figure 2), and 10 minutes later, the room smells like a tanning salon, but the UV light has deactivated everything from coronavirus to MRSA, C. difficile, and other pathogens. This technology saves us time and manpower, as we used to hire people to come in on weekends to take care of the heavy-duty cleaning.

“We’re constantly sanitizing the air and surfaces with UV light, and this has helped everybody, including our patients, feel more comfortable,” Dr. Mahootchi says. “We’re showing patients that we’re making an extra effort to keep them safe.”

Regardless of the mitigation efforts you choose to take, Dr. Mahootchi urges all surgery centers to make sure patients are aware of them.

“Just as there’s a second wave of the disease, there should also be a second wave of your public relations message, describing what you’re doing now that the numbers are rising,” he says. “Have the staff members who work your phone bank practice your messaging and instruct them to listen for signs of hesitation from patients. Sometimes, just asking, ‘Are you afraid about COVID-19?’ creates an opportunity to address patients’ fears and reassure them by listing exactly what you’re doing to minimize their risks.”