Although ASCs save money and increase efficiency while providing high-quality care, efforts to further improve efficiency are ongoing. And in today’s fast-paced environment, efficiency is a moving target, and there is always room for improvement.

Case in point: A 2015 study of cataract-surgery-focused ASCs in California found that many centers were operating at low technical efficiency levels.¹ Knowing this, the makers of surgery and small procedures chairs and equipment have set their sights on helping ASC teams move patients through their centers more safely, comfortably, and efficiently. Here are some points to consider when outfitting your ASC.

Manufacturer Goals

“We are always focusing on safety, comfort, efficiency, and reducing wasted time,” says Jeff Baker, president of MTI, a company that designs, manufactures, and sells medical furniture for ophthalmology and other specialties.

Baker says his company’s most efficient surgery chair is the MTI 440 Mobile Stretcher Bed, which allows for pre-operative care, patient transport, surgery, and recovery in the same motorized bed. That means no time-consuming and potentially unsafe transfers to gurneys.

“Imagine a 110-pound nurse trying to transfer a 310-pound patient from a gurney to a surgical table,” says Baker. “Even if the nurse has assistance, it’s fair to say that staff members are at risk for injury. The patient could also be injured. These risks are eliminated by a mobile, adjustable chair that increases safety — and improves throughput.”

Baker notes another advantage of mobile chairs is that they can be configured into chair position when not in use, thus occupying up to three times less space than gurneys. Furthermore, “too many gurneys moving through the center can create a traffic jam,” he says.

Examination and Procedures Theater

Reliance Medical Products, part of the Haag-Streit corporate family, recognizes that chairs are critical components of the examination and minor procedures theater.

Chris Blizzard, director of sales and products marketing says, “We offer patient positioning and instrument delivery equipment designed to improve office efficiency, patient safety and comfort, and practitioner considerations.” When buying a minor procedures chair, he recommends keeping the following considerations in mind:

• Surgeons need to operate the chair hands free. “You should be able to control the chair with a foot switch — adjusting the patient height, changing the angle of your approach, and reclining the patient as needed,” says Blizzard. “For most procedures, you should able to recline the chair to a flat or near-flat position.”
• The chair should have a lock-out system, preventing it from moving inadvertently. The ability to swivel the chair and lock it from both sides is also valuable.
• The chair also needs to help the doctor maintain a comfortable posture. “Look for a small footprint and easy access to the patient,” notes Blizzard.
• Chairs should be comfortable and durable. Comfort helps to reduce patient stress, and durability makes good safety and financial sense. Ask your equipment sales representative to explain the construction of a chair, specifically the furniture substrate and materials that support the patient.

Consider Outcomes

“We think in terms of outcomes,” continues Blizzard.

• Does the chair allow you to be more efficient?
• How does it help with surgeon fatigue during and after procedures?
• Does the chair increase safety, especially when considered within the Outpatient Prospective Payment System rules? “You need to ensure safety,” says Blizzard. “For example, select a chair that can lift 500 pounds without tipping.”

Power Lifting

Baker says the power capabilities of MTI chairs are important because they help nurses choose appropriate patient positions without having to use pillows or make multiple adjustments. In fact, some frequently used positions can be programmed into the chairs to support specific procedures.

Other, modified chair positions are useful in special circumstances, such as lifting a short patient into a high position. The ideal chair provides preferred positions for each surgeon, Baker notes.

“You can minimize time spent adjusting the chair for the physician,” says Baker. “You don’t have to adjust it manually.”

When transporting a patient from the pre-operative setting to the OR with a mobile chair, staff can make the chair higher and easier to push, so nurses don’t have to lean over the patient’s head, with the chair pushing uncomfortably into their stomachs.

“The patient sits down in a chair that is programmable,” says Baker. “Surgery staff can put the patient in the entry position, so drops can be put in his eye. After wheeling the patient into the OR, staff can program the chair to lift the patient back up.”

New electronic designs with improved, longer-lasting lithium batteries have made development of the mobile chair possible.

“The batteries last all day without needing to charge,” adds Baker.

The MTI Mobile Stretcher Bed also has an ultra-thin back.

“As we know, the distance between the scope and the eye needs to be a specified length,” he points out. “The thicker the chair back, the more the chair needs to be raised for taller surgeons, so they can get their knees under the chair. Maintaining the specified length forces the binoculars higher, requiring taller physicians to crane their necks.”

Besides improving ergonomics, increased separation between the thinner chair back and the bag hanging on the IV pole helps keep the lens bag filled during phacoemulsification.

Enhancing Efficiency

The newer chairs all respond to the increasing need to perform more efficient surgery.

“The faster the physician works, the more chairs you will need,” says Baker. Increased efficiency means more patients are moving through your center each day.

Like most chairs, the Reliance offerings save time in increments. “A chair that provides greater efficiency may allow you to trim 1 to 2 minutes from each procedure,” Blizzard notes. “If you perform 20 procedures a day, you can see more patients or use that time for better work-life balance.”

Rather than rushing patients, Blizzard says efficient chair design can improve the patient experience. This is especially true when a physician is performing injections and other small procedures with an instrument delivery system that increases efficiency.

Reliance’s I-OPS Delivery System provides a customized Mayo tray within arm’s reach of the surgeon, who can use one hand to hold a lid speculum in place and the other to reach for a dropper bottle, syringe, or other item to perform the procedure with his or her free hand.

“There is more quality time with the patient,” Blizzard says, “because the physician isn’t reaching for instruments or turning his back on the patient.”

Physicians also appreciate the system.

“Even with a scribe assisting, intravitreal injections, like many other in-office procedures, can be awkward and inefficient,” says Christopher D. Riemann, MD, of the Cincinnati Eye Institute, who helped develop the I-OPS system. “I-OPS is an ingenious but simple solution.”

Baker says MTI has enhanced its mobile chair by making room for on-board IV poles and oxygen tanks. A drape is provided to protect the patient from fluid from phacoemulsification and also cover oxygen lines. Mayo assemblies, chart holders, and monitor posts are also offered in conjunction with the mobile chairs.

As the future unfolds, you can expect more of these innovations aimed at improving efficiency.

“I think it is safe to say that companies will continue to respond to the need for better and faster ways of doing things,” says Baker. ■