About one-third of the cases at our facility are children, owing to the large volume of ENT procedures we handle. Here are five things we've done to ensure the children and their parents are as comfortable as possible on surgery day.

• We use the services of a board-certified pediatric anesthesiologist to cover these cases.
• Stuffed animals, video games and movies are available for both pre- and post-op enjoyment. We bought PlayStation 2 for some of the pre-op rooms (pictured) the game system also plays DVD movies.
• We offer to give tours of our center in the days before surgery for children and their parents.
• Even if there's no time for a tour, we hand out an information booklet pre-op that's designed for both parents and kids.
• Parents are allowed in recovery almost immediately post-op; children have beds separate from the rest of the patients.

Pam Ertel, RN, BSN
Administrative Director
Reading Hospital Surgicenter at Spring Ridge
Wyomissing, Pa.
writeMail("[email protected]")

A quick mend for your billing
We've developed a system for what we call no-stress closing at the end of the month. Instead of stressing out in an effort to generate bills for those accounts that have not been coded, we use a "mend" code. We post a charge of $1.00 to those open accounts. Once the procedure has been correctly coded and can be billed appropriately, we change the $1.00 to the actual amount and forward the bill. In addition to enhancing timely reporting, this practice has helped to minimize the overtime the billing department was generating.

Marva Nisson
Patient Account Representative
Millennium Surgery Center
Bakersfield, Calif.

Faster, cheaper, CE
Making sure staff get the continuing education units they need is time-consuming for them, expensive for you and can be stressful for everyone, especially in this age of streamlined staffing plans and nursing shortages.

Looking to alleviate these problems for my staff and myself, I stumbled on a solution that has worked out great for us: Web-based CEU programs. You can search online for courses; a comprehensive list is posted at www.medi-smart.com/freeceu.htm, and a simple search for "online nurse CEU" on a search engine such as Google (www.google.com) will turn up more results than you can shake a stick at.

The program I ended up subscribing to costs just $30 per person per year. I signed up our nurses and techs - everybody who needs contact hours. The courses cover many outpatient surgery-applicable topics, such as age-specific competencies, malignant hyperthermia, prevention of surgical site infection, needle safety, HIV - just about everything your staff needs to keep up with CEUs. The user takes the course online, takes the test and, if she passes, gets a printable completion certificate.

Suddenly the monkey's off everyone's backs to figure out contact hours, because the Web site keeps track of everything under each user's unique account and we also have the certificates. If a nurse's contact hours are randomly audited, she can just go to her file and pull out her certificates. Accreditation surveyors for AAAHC indicated that they especially liked this method because it meets their standard of providing staff with access to continuing education.

Nurses love it because they can take courses at their own pace and do them at home if they want to. Some will come in a bit early or spend downtime studying online. I love it because I'm spending a lot less money. At minimum, between travel, hotel and sign-up fees, sending a nurse to a conference costs $500. She's lucky to come back with 10 hours, and in Ohio, you need 24 hours every two years. By paying $60 per nurse every two years for all 24 CEUs, I'm saving our facility thousands of dollars.

No one has to take time away from family, and I don't have to worry about covering shifts while staff are out of the ASC. I've had just one request for an out-of-town conference since I started using Web-based CEUs.

Carol Fairchild, RN
Manager
Holzer Clinic ASC
Jackson, Ohio
writeMail("[email protected]")

Make a no-negativity rule
As a manager, I know the first and most important thing that you need to instill in employees is respect; mutual respect is the fundamental requirement for success in any business, especially one as serious as surgery. This starts during the interview process and selection of your staff: A professional can learn any aspect of his job, but personalities don't change.

In our center, respect for our staff members, patients and their families, the physicians and their office staff, and our competition is mandatory - we do not tolerate bad comments, rumors or anything else that creates a negative environment but support a positive, respectful environment. In short, expect respect. The easy-to-implement way to make this happen: Ban negative talk so a negative environment is not created.

To emphasize this, we invited Joe Tye, the author of Never Fear, Never Quit, to come to our center for a one-day class on his "12 Core Action Values." He posed this challenge to our center: to create what he calls a "positively positive environment." For the next two weeks, we all carried 3-inch by 5-inch index cards in our pockets and documented any negative comments we overheard, which would then be addressed at a later time. Because all staff members attended the conference, everyone knew the rules, and we ended up with a multitude of consecutive days during which not a single negative comment was made. It takes 20 days to form a habit, so we aimed for that many days with no negative comments (NNCs). Now, NNCs are a way of life for us every day.

Kathleen Allman, RN
Administrator
Millennium Surgery Center
Bakersfield, Calif.
writeMail("[email protected]")

Cut office supply costs by recycling
If you find old notebooks and folders in desks that former employees have left or that have simply been forgotten about, don't just throw everything away. Overhead for office supplies is costly. Instead, re-use folders and tear the used pages out of notebooks. Clear plastic sheet protectors are expensive, bad for the environment and can also be reused if they've been treated gently. Get rid of the outdated papers but keep the sheet protectors. Remind your clinical staff who work in the office to save these supplies by reminding them that every little bit you save in the office can be applied to the clinical budget.

Leah J. Hamilton, RN, BSN, RMT, LE
Staff Nurse
Southwest Cosmetic Dermatology Associates
Fort Worth, Texas
writeMail("[email protected]")