Article

Mastering the Patient Flow

Experts share insights on how to decrease wait times and increase efficiency

Have you maximized patient flow in your ASC? If your patients regularly experience wait time, or even if you just run into some hold-ups once in a while, these three ASC professionals have the tips and strategies to help you start on time, end on time, and keep patients moving.

Integrated Clinic and ASC Staff

LARRY E. PATTERSON, MD
Founding Partner, Eye Centers of Tennessee, Crossville, TN

In a single-OR ASC that is under the same roof as the practice, everyone from receptionists to surgical techs can coordinate their work to help things run smoothly. We have a set plan in both places to make sure patients are thoroughly prepared for surgery day and have a seamless experience in the ASC. The surgery center coordinator is in the ASC on the day of surgery, verifying surgical plans and helping turn over the rooms. We’ve been doing this a long time, and it’s all quite efficient today.

Best Tips for…

…Speeding Up Single- OR Turnover

According to traditional hospital teaching, patients shouldn’t be brought to the OR until it’s completely ready. That wastes time. When the room has been cleaned and the techs are starting to set up, bring the patient in, get the bed positioned, and prep the patient while the scrub tech continues to set up. It’s a much better approach to patient flow than parking someone to wait for the OR. Our inspectors agree!

…Mastering Patient Flow

Learn about new strategies for patient flow by visiting other ASCs. We picked up a great deal over the years, including the vast majority of the techniques we use for good surgery day flow and a positive patient experience.

Preparation Is Key

Having every patient properly prepared for surgery day is fundamental to good flow. That process hinges on the office and surgery center staff. Our surgical coordinator meets with patients after their cataract evaluations to explain what will happen the day of surgery, what costs they can expect to pay that day, what they may pay later after insurance is filed, what to do before surgery, and what to bring to the ASC. Patients take home some paperwork to fill out and bring with them on surgery day, and a staff member calls them a few days before surgery to go over everything again and answer questions.

In the surgery center, the staff looks over the day’s schedule and makes sure we have all the right equipment and supplies on hand. It’s really because of our experienced, phenomenal staff that our surgery schedule is so effortless.

Putting a Good Face on the Practice

When we survey our patients about their satisfaction, 95% to 99% say everything is great — nothing to improve. Someone might say the blood pressure cuff was uncomfortable, but otherwise, we do very well. Again, the credit goes in large part to our staff.

Our patients don’t feel rushed. They actually tell us they’re impressed with our efficiency because they don’t have to wait. The nurses preparing patients for surgery work very efficiently, and they’re chatting all the while to put people at ease. We want people to feel like they’re family. We also want to keep them moving so no one is waiting too long and everyone goes home satisfied with the experience.

“One Way” to Streamline Flow

NIKKI HURLEY
Director, Key-Whitman Eye Center, Dallas

To reach our goals for patient flow, we needed a concerted effort from staff and surgeons alike, but another talented strategist laid the groundwork in our ASC: the architect. To keep patients moving with no hallway traffic jams, our ASC is physically designed for one-way flow.

Clear Direction on Surgery Day

Our staff makes surgery day efficient by ensuring patients know exactly when to arrive, what to pay, and what to expect from surgery. A pre-op nurse receives patients as soon as they check in with no waiting. In pre-op, as patients get their monitors set up and ask questions, the staff is chatting with them to calm their nerves. They start anesthesia, go into the OR for about 15 minutes, and then go to post-op, receive their instructions, and get discharged.

Best Tips for…

…Scheduling Complex Cases

Some patients with high deductibles wait longer for surgery, putting it off until they have harder cataracts. We schedule those patients on a separate surgery day from routine cataract cases and provide them with longer time slots. We use RFID data to know just how many time slots surgeons can handle for tough cases, so patients are cared for efficiently without waiting.

…Addressing Last-Minute Problems

We’ve had patients get all the way to pre-op and ask questions that temporarily hold up surgery. If a patient asks, for example, “Why is my other eye red?” then a trip to our clinic upstairs is in order. In these cases, the next patient is ready, so we can hold the patient’s chart, keep moving, and work that person into the flow later if the exam shows everything is OK for surgery.

As patients move through these steps, they’re on a one-way path through the ASC. From the reception area, they go through a hallway to one of five pre-op bays, and then to one of the four ORs (two surgeons, each with two rooms). They exit the OR through a different door to a different hallway that leads them to post-op, so there are no patients moving in different directions through the hallways. Scrub techs and Sterilization techs use separate doors in the back of the ORs to dedicated hallways, so their path doesn’t overlap with patients and nurses.

To avoid any holdups from the femtosecond laser, it has its own room and a dedicated physician. For doctors who prefer to do their own femtosecond work, we schedule fewer patients.

Live Traffic Information

We track patient flow using an RFID system, which shows us how long patients stay in each area of care, as well as surgery start and end times. We can see our results in graphical form, which makes it clear where we may need to smooth things out. Also, it helps us show doctors if they’re slower, so they see why they need to have one less slot to ensure patients don’t wait. For the last 3 years, we’ve shared patients’ RFID numbers with the family member who drives them, which lets that person track where the patient is throughout the process on a TV screen in the lobby. All of these efforts help ensure that we meet all the goals of patient flow, from avoiding wait time for our patients to performing surgery at the pace we desire.

See Problems Before They Happen

MARK KONTOS, MD
Senior Surgeon and Partner, Empire Eye Surgeons, Spokane, WA

Every 5 to 7 minutes, one patient leaves and another one enters. That’s the goal for our team, and we track and log patient flow every day so we can evaluate the numbers to reach that goal. Patients see a process that moves smoothly from the arrival to the ride home. There’s no chaos, no delays, no long waits. A lot goes into making that work, not the least of which is identifying problems before they happen.

When everything is moving efficiently and according to plan, there’s a rhythm to surgery days that just works, but that rhythm can be thrown off dramatically when unexpected issues arise with our patients. Every time our team looked at ways to reduce surprise delays, we found a few simple changes that helped us identify patients who might cause a delay.

Turning a Savvy Eye to the Consult

It starts with the consultation. That’s my opportunity to observe anything about the patient that might slow us down in the ASC, clinically or otherwise. If a patient doesn’t dilate well or takes a long time to ambulate, for example, I note it on the chart that goes to our surgical planners. They understand that the case will not be quick and easy in the ASC, and the planner schedules surgery right before lunch or at the end of the day, so we don’t hold up other cases. In patients with dilation problems, the notes also let me know that I should tailor my approach on surgery day to prevent any dilation-related delays.

Best Tips for…

…Sustaining a Complete, Engaged Staff

To meet concrete goals for patient flow, you need a team that’s involved and engaged, focused on the goals for patient flow, and not clock-watching for the end of the workday. Our staff is cross-trained, and we rotate them to make sure everyone has breaks and stays fresh. And because, for example, all our surgical technicians can scrub, sterilize, run the laser, and help nurses in pre- and post-op, we’re never short of staff, which helps patient flow, too.

…Keeping Patients Relaxed and Happy

Efficient flow can’t come at the expense of making patients feel rushed or nervous. Our staff chats with patients to take the edge off. Although we try to answer everyone’s questions during the consultation, we sometimes hear some questions or doubts on surgery day. It’s important to take the time to make sure a patient is happy.

As I talk to my patients, if I get the sense that someone is not fully alert, I note that the person is at risk for not following instructions. Our team doubles the effort to talk to a family member about the pre-op prep, such as not eating breakfast on surgery day. Now, they rarely arrive in the ASC having eaten breakfast beforehand or forgotten other pre-op steps.

A Plan for Complex Cases

Other details of the cases call for special scheduling to avoid delays. We time femtosecond laser cases so we can use the laser in its room and then have the patient ready on time for surgery. We’ve found the best way to do that is to avoid scheduling femtosecond cases in the first two slots of the day. Similarly, complex cases such as patients who require vitrectomy, a capsule tension ring, or even corneal transplant are scheduled for the end of the day.

All these efforts are a preemptive strike — seeing and addressing problems before they happen so everything goes smoothly in the ASC. We can’t plan for everything, but we have managed to make preventable delays very uncommon, and patients move swiftly and efficiently through the ASC. ■