When it comes to making an ophthalmology ASC run at optimal efficiency, veteran staff and industry experts say it mainly comes down to factors such as the number of operating rooms, training of staff members, equipment placement and medication use. Here, they detail their battle-tested tactics for smooth, profitable, patient-centric functioning.

ONE ROOM OR TWO?

If a surgery center has one physician, having one operating room will most likely be the most efficient use of space. Rob McCarville, MPA, the managing principal who heads the ASC division at Medical Consulting Group in Springfield, Mo., says many surgeons can perform three or four cases per hour in one operating room during an 8-hour period. That results in 24 to 32 cases in a day.

Vanessa Sindell, MSN, BSN, RN, senior consultant, Progressive Surgical Solutions, a division of BSM Consulting, Seal Beach, Calif., says, “If a physician can do 25-plus cases before noon, that level of efficiency may require two rooms but can be done in one with appropriate staffing.”

Medical Consulting Group works with one ASC that has six surgeons sharing one operating room. They perform up to six cases per hour and 4,000 cataract surgeries annually.

“They are very efficient in how doctors operate, how staff can turn over the OR and the instrumentation they use,” says William B. Rabourn, Jr., managing principal.

Should two operating rooms be necessary for optimum efficiency, the ASC will require more staff — which means added cost. “The case volume will need to justify it,” says Anita Henson, RN, BSN, nurse consultant, Medical Consulting Group.

Regarding the number of beds, sometimes state or facility regulations dictate requirements. Typically, each OR has at least two preop and two postop beds. Oftentimes, beds are specially designed eye gurneys with articulating headpieces. Ideally, the patient is placed on the gurney in preop, rolled into the OR then rolled to recovery after surgery — so the patient is never off the gurney.

“This increases efficiency and allows the patient to be monitored throughout the process,” says Stephen C. Sheppard, MS, COE, managing principal, Medical Consulting Group.

STAFF FOR EFFICIENCY

The number of surgical staff an ASC needs is determined by the number of ORs and cases. Each OR needs a full team including one registered nurse, one surgical tech and one instrument tech. The surgical tech assists the surgeon, and the instrument tech helps turn over the room, opens the next case and cleans and sterilizes instruments. In addition, each room must have an RN circulator whose primary role is to address patient safety and advocate for the patient, Ms. Sindell says.

To foster efficiency, Diana Buck, RN, BSN, CNOR, nurse consultant, Medical Consulting Group, advises either cross-training scrub and instrument techs so they can serve in both roles or having a float tech or nurse unassigned to a specific position so they can jump in wherever things get behind, such as a patient needing extra care.

A non-licensed coworker or non-licensed nurse assistant can help with lower-level tasks, such as cleaning in between patients and escorting a patient to their car — which will keep flow moving in a timely manner, Ms. Henson says.

MAXIMIZE PATIENT THROUGHPUT

It’s also important that facilities streamline processes in preop and post-anesthesia care units (PACUs), so tasks like administering eyedrops or inserting an IV can be executed quickly and staff still have time to engage with patients, Ms. Sindell says. Items such as compounded eyedrops, pre-packaged IV sets, standardized orders for all cataracts cases and easy medical record forms with check-off boxes can all help reduce nurses’ workloads and create more time for patient interaction, she explains.

While efficiency is critical, it’s important to ensure that patients do not feel as though they’re being run through a mill when at an ASC. “It’s imperative that staff try to minimize this feeling,” Ms. Sindell says. “Tasks need to be completed efficiently and with a personal touch. Teaching staff to incorporate customer service into their nursing care is imperative.”

Small gestures such as making eye contact and offering a warm blanket and magazines can help make patients feel that they are getting one-on-one, customized care.

An ASC can create efficiencies by doing the same things repeatedly day after day. “By ensuring patients that this is what we do every day, and that this is all that we do, they can see that we are focused on giving optimal care, which is comforting to them,” Mr. Rabourn says.

Ms. Henson agrees. “When patients observe that the staff works as a team, it helps put them at ease.”

KEEP MEDICATIONS TO A MINIMUM

Sedating patients as minimally as possible means shorter stays in the ASC. Most cataract surgeries can be done with topical numbing eyedrops alone. Oral diazepam is a great alternative to IV sedation for anxious patients. The patient takes it at home before their procedure and another dose in preop. “It takes the edge off,” says Ms. Henson. “Then the patient will only need topical numbing eyedrops before a procedure begins.”

The preop nurse monitors the patient until they go to the OR, where they are then monitored by OR staff and then the postop nurse.

Similarly, oral midazolam — the sedation drug normally given via IV — is a good option for nervous patients who don’t want an IV or if it’s hard to gain vein access. The patient is still awake during surgery but is mildly sedated and calmer, says Ms. Buck.

“Patients can go home faster after their procedure, and anesthesia risks are greatly reduced with minimal sedation,” she explains. “There is very minimal postop recovery; patients are usually ready to leave the center in as little as 15 minutes after surgery with mild sedation (some [oral] midazolam).”

Depending on a surgery’s complexity, some patients may require a peribulbar block or a retro-bulbar block — an injection around the eye to numb the optic nerve to reduce the degree of pain a patient can feel during these procedures, Ms. Buck says. Usually, these patients are given an anesthetic such as propofol during the eye block, so that they are asleep during the injection and don’t feel anything. This medicine wears off quickly and the patient only sleeps for 5 to 10 minutes. In another 15 to 20 minutes after awakening, patients are typically ready to leave the ASC.

Either the surgeon or an anesthesia provider trained in eye blocks can perform the block. Ms. Buck recommends this be done in the preop area for efficiency.

If anesthesia is needed, it’s best to administer it just before a patient enters the OR, which ensures they will need the least amount, says Ms. Sindell.

CONCLUSION

ASC efficiency requires a multi-pronged approach involving the entire staff. While that may sound intimidating — particularly in light of the backlog of cases facilities are facing after the COVID shutdown — the tips offered by both consultants and veteran staff show efficiency is attainable. OM