There's always room for improvement in your cataract surgery program. Here are tips from your colleagues to work smarter and faster.

1 Use 2 rooms per surgeon. The secret to cataract efficiency is zero down time, so that no one — including the surgeon — is standing around waiting to do what they've been assigned to do. When you have fast surgeons, using 2 or more rooms gets rid of the wait. The surgeon can walk back and forth between rooms. "You have to have the numbers to do it," says Kristi Morse, RN, nurse manager of compliance and administration at the Pacific Hills Surgery Center in Laguna Hills, Calif. A surgeon needs to be quick enough to keep the staff busy in each room. At Ms. Morse's facility, a surgeon needs to bring in 14 cases a day in order to open 2 rooms. Any less and the 2-room setup is not as profitable because of the staff required, she says.

Nearly two-thirds (64.5%) of the 279 eye facilities we surveyed last month use 1 room. The Physicians' Eye Surgery Center in Charleston, S.C., is among the 35.5% of surveyed facilities that use 2 rooms. Their magic number is at least 4 cases an hour, says Jennifer Blanton, RN, the clinical nurse manager.

The Lakeland (Fla.) Surgical & Diagnostic Center has a team of 2 techs and 1 RN. Executive Director Emily Duncan, RN, BS, CASC, explains that 1 tech scrubs and the other opens, assists with startup, takes the instruments to sterile processing and helps with cleanup and room turnover. "We have a 3-minute turnover, long enough for the disinfectant surface contact time," she says.

The 2-room strategy can backfire if your surgeon's not fast enough. "For slower surgeons it just ties up staff that could be performing other duties," says Denise A. Fake, RN, administrator of the Hanover (Pa.) SurgiCenter.

2 Create a floater position. Having a cross-trained person who can help with turnover in the rooms, go back and forth between the semi-sterile room and the OR or fill in during breaks can help keep things moving swiftly. The job description for this person varies by facility. At the Rummel Eye Center in Prescott, Ariz., the floater is called the "circulator's advocate." This position helps with the equipment turnover between cases, cleans and wraps the bowls and takes care of reprocessing dirty instruments in the semi-sterile room. During a case, the circulator can ask the advocate for a bowl or an instrument and still focus on what she's doing "without having to run across the room," says Joanie Allen, COMT, BA, surgical administrator for the Rummel Eye Center. When it's necessary to flash instruments, the circulator's advocate can prepare and transport the closed sterilization trays used in flashing.

At the Southwestern Pennsylvania Eye Surgery Center in Washington, Pa., the "instrument nurse" goes back and forth between the semi-sterile room and the ORs. Although it's more costly to pay an RN to do this, a nurse can also relieve team members for lunch breaks and stay late for retina cases, says Mary Roth, RN, clinical director of the surgery center.

3 Keep patients dressed. With some patients, undressing before surgery and getting dressed afterward can take as long as the cataract procedure itself. So keeping patients dressed while they pass through your facility can save plenty of time. At the Pacific Hills Surgery Center, patients leave their clothes on but put their shoes in a bucket under the bed. They have a gown over their clothes and wear a hat. It also saves time after the procedures when groggy patients can take as much as 5 minutes to get dressed.

The Buffalo Ambulatory Surgery Center in Cheekto-waga, N.Y., instructs cataract patients to wear a short sleeve button-up shirt, which gives staff easy access to the chest if they need to attach monitoring devices there, says Administrator Dorothy Zimdahl, RN, BS, CNOR, CASC.

4 Use stretcher chairs or tables. With a stretcher chair or table, there's no patient transfer to and from the OR table, which can take time and possibly lead to patient injury from a fall or staff injury during the transfer. Once the patient sits down, she never has to move again until discharge, says Karen Chiles, RN, BSN, administrator of the Commonwealth Eye Surgicenter in Lexington, Ky. Having ECG monitors attached to the stretcher is a way to save even more time. "Once the patient is hooked up in pre-op, nothing is changed or removed until discharge."

5 Outsource cataract services. If you're planning on adding cataracts or only receive cataract patients a couple of times a month, outsourcing is an option that requires no capital investment. Plus, you don't have to find a place to store the equipment on the days you're not doing cataract cases.

"Outsourcing saves us money. We don't need to update equipment, keep supplies on the shelf or have lenses in stock," says Janis Gartner, RN, a nurse at St. Joseph's Hospital and Health Center in Dickinson, N.D., where cataract surgery is done once a month by a surgeon from another town who usually brings about 10 cases.

You can also outsource your instruments for cataract procedures to a processing company. "We have 30 full instrument sets that we use, so we just have to pull a set and we are ready to go," says Brian Moser, MBA-HCM, COT, assistant administrator of the HEA Surgery Center in Houston, Texas.

6 Streamline your documentation. If you have a multi-specialty surgical facility and use paper documentation, create concise charts and nursing note documents specifically for cataract procedures. This will save the physicians and nurses time because they won't have as many pages of questions and check boxes to wade through. St. Joseph's Hospital edited out all the sections related to specimen collection, says Ms. Gartner.

7 Dilate as soon as possible. Your staff and surgeons shouldn't be waiting for a patient's eye to dilate. Have your patients arrive pre-dilated from sample-size bottles or administer the drops as soon as the patients arrive. At the Buffalo Ambulatory Surgery Center they created a "drip room" and a "drip nurse" position to get the dilating drops in the patients as soon as possible. The drip nurse is in the drip room, formerly a changing room, all day. There she interviews each patient, has them sign all the consent forms and administers the drops. "Their dilation is started within minutes of hitting the registration desk," says Ms. Zimdahl. Getting the drops in quickly speeds up the process because no one is waiting for a patient to dilate. In cases where a patient is dilating slowly, there's usually a patient who is already dilated who can move ahead, says Ms. Zimdahl.

8 Keep a rein on your surgeons. Some surgeons are faster than others in the OR. But at the end of the day, operating speed is not necessarily the key to efficiency. Focus and teamwork are more important. The most efficient surgeons, say many managers, are those who stay focused between cases. If a surgeon takes just 6 minutes to perform a procedure but spends 15 minutes on the phone or computer between cases, the surgeon isn't necessarily effective. It's a delicate task, but you need to keep your surgeons focused. "It's traffic control," says Ms. Morse. "They go wandering off."

If the surgeon is working a pair of rooms, it's easier to keep him focused because he knows he has to walk into the next OR where everyone is waiting for him. If the surgeon is working a single room, constant communication is the key. Good RNs and techs know their jobs as well as what the surgeon should be doing so that they can remind the surgeon, if needed. "They keep them on task," says Ms. Zimdahl.

Having enough instruments helps too, says Ms. Allen. That way the surgeon is not standing around waiting for the instruments to come back.

9 Don't forget safety. You can reconcile efficiency and safety, says Nancy King, RN, BSN, CRNO, an ophthalmic nurse from Phoenix, Ariz. "When you have to wipe everything down, is 1 person doing it or are 2 people doing it?" Efficiency also means making sure equipment is ready and the right supplies have been brought out. During the the pre-op time out, make sure you show the IOL to the surgeon; otherwise, you'll be scrambling to find the correct package during the case. If you build safety into how you do everything, every time, efficiency during cataract cases will come naturally, says Ms. King.