2 Tips for Tighter Scheduling

Procedures that run overtime, doctors and patients who arrive late, operating room time slots that are reserved but never used - all these incidents eat into your ambulatory surgery center's profitability. To avoid them, it's critical to make sure every minute is well used and be prepared for every procedure. In this article, we'll show you how several facility administrators accomplish the first goal by establishing firm policies for using block time and tackle the latter task by making sure surgeons and their office staffs know and follow specific instructions.

Manage Block Time Wisely

Surgeons love being able to reserve operating room time, but it's up to you to make sure that they are using that time as efficiently as possible.

Here are some important things to consider when administering block time:

Know Your Surgeons: It's important to offer coveted time slots to surgeons who have a history of high volumes, says Veronica Melendez, RN, administrator of the Specialty Surgery and Pain Center in San Antonio, Texas. When surgeons request time, she advises, always ask how many cases they performed per week previously and what their previous turnover times were. Unless you are absolutely sure that the time will be used, it may be a good idea to assign one or two blocks on a trial-period basis, while you monitor and become familiar with a surgeon's work habits. Renee Edwards, RN, department head and nurse manager of the Christus Santa Rosa Surgery Center in San Antonio, agrees. When her hospital-owned, multispecialty center first opened, she granted only six doctors, who she knew would have heavy caseloads, permanent block time slots. Others received time on a trial-period basis. "You have to know your doctors - the ones that will show up late, the times it takes them to do the procedures, etc., and adjust the time accordingly," she says.

Monitor Utilization: It's best to track block time usage on a regular basis, even after the trial period is over. At the HealthSouth Exeter Surgery Center, a multispecialty ASC in Reading, Pa., if a doctor doesn't use at least 50 percent of the time, it is cut back, says Cindy Stanson, director of nursing. Other centers are even more strict; at the Mercy Surgery Center, a multispecialty facility in Havertown, Pa., doctors must use at least 70 percent of their block time in order to keep it, according to nursing director Debbie Tucker.

Have a (Flexible) Cut off Date: You should have a firm policy of how far in advance a doctor must book cases before a slot is given away. One week is a good guideline, but be prepared to be flexible. "Ophthalmologists and cosmetic surgeons know far in advance what cases they will have, so one week is plenty of time; however, orthopedic surgeons' cases are more erratic," says Ms. Tucker. Mercy's orthopods, therefore, get a little more time to firm up their plans.

Know When to Let Go: When a surgeon's block time needs to be cut down, make sure you present him or her with all the facts as professionally as possible, since it's inevitable that some surgeons will take the news personally. At Exeter, surgeons whose volumes have been dropping consistently receive a form letter, with the percentages of time used spelled out in black and white, says Ms. Stanson. If you've been diligent about monitoring utilization and can prove that the surgeon hasn't been using the time allotted, he or she will be hard pressed to argue with your decision.

Working with Surgeons' Offices

Since you usually won't see patients until the day of surgery, it's critical to ensure that the surgeons' office staffs know what information they need to send you and how to prepare patients for their procedures. Here are some ways to make sure they understand and adhere to your policies:

Arrange a Meeting: When a new surgeon joins the facility, invite his or her employees to visit your center to meet your staff and learn about your policies and procedures. Mercy Surgery Center makes this initial meeting a business as well as a social get-together, and serves breakfast or lunch to the visiting staff. At Specialty Surgery Center, they use the initial meeting to distribute information that the surgeons' staff can give to patients, including a map to the center and general pre-op instructions.

Don't assume that one face-to-face meeting will be sufficient, says Ms. Stanson. Surgeons' offices often have high employee turnover rates, so she suggests that you re-establish contacts and keep emphasizing your procedures regularly.

Develop a Protocol: Establish a protocol for getting patient information from the surgeons' offices. Some centers, like Exeter and Christus Santa Rosa, require surgeons' offices to fill out a "face sheet" with the patient's name, address, insurance information, diagnosis, and procedure needed (click here for an example). The surgeon's office faxes this form to the surgery center to start the scheduling process. A surgery center staff member then calls the office to firm up the date and time of the procedure. A face sheet ensures that you have critical information in writing and saves your scheduler from having to collect it over the phone.

When establishing relationships with surgeons' offices, emphasize that getting as much information as soon as possible is key. This is especially important for getting insurance precertification numbers, says Ms. Edwards. "Doctors often want to do things very quickly without getting precertification numbers, so we're working to open up the lines of communication with them and make sure we get this information as quickly as possible," she states. While Medicare and Medicaid do not require precertifications, most commercial insurers do, and most of them require three days before they issue a precertification number. Scheduling is an ongoing, demanding, sometimes frustrating task, but by forming firm policies and keeping the lines of communication open, you can master the process. A smoothly running facility and better patient care will be the results.

Software for Smarter Scheduling

There are a number of software packages to help you schedule OR time. Here's a brief description of three of them. Surgicenter Information Systems: This Windows-based scheduler has an interface that resembles a daily planner. You can use it to assign block time and record how much time a procedure actually took. The program will then build a database of how long doctors are taking to perform procedures, allowing you to track utilization. When a surgeon schedules a case, the program "remembers" how long it usually takes him to perform that procedure, and puts at least that much time in the schedule. Camberley Systems: This company has just added patient tracking to its SurgeOn Windows-based scheduler. Patient tracking allows your staff to track patients on a kind of electronic whiteboard, similar to the airline status screen at an airport. When a patient moves from registration to pre-op, for example, the staff updates the whiteboard. When a family member asks how a patient is doing, the receptionist can see that the patient has just entered surgery with just a glance at the screen. Temple SurgiCenter Systems: This scheduler allows you to export reports into Microsoft Excel or Crystal Reports. It also includes the following features:

-- historical procedure times;

-- block scheduling;

-- equipment tracking; and

-- payer approval information.