We send each cataract patient home with a narrated videotape of his procedure. It costs about $25 to do this when you consider the expense of the recording equipment, on-site narrators (yes, that's right - narrators) and blank videotapes. Multiply that by the 5,000 cataract cases we do per year and $125,000 might seem like a hefty number, but it's proven to be a great way to market our vision care and cosmetic facial surgery practice in southwest Florida. We also use our sophisticated video equipment to conduct live surgery seminars for the public in an effort to help demystify cataract surgery. Here's how we've set up to do this.

Outside two of our ORs are observation rooms where relatives and friends can view cases. We ran a line from the camera mounted on the OR microscope to the observation room monitor so that the same video feed displayed in the OR runs there. One of our two surgical narrators sits in this room during surgery; one's a former pharmaceutical rep who transcribes for us 10 hours per week, the other's a former medical assistant who works at the ASC reception desk for us 20 hours per week. Surgeons and other narrators train new speakers on the job. We randomly watch and listen to tapes as a quality assurance check and provide feedback as necessary.

The narrator first reviews the anatomy of the eye, then describes the procedure from incision to phacoemulsification to insertion of the IOL. When the surgery is over, the surgeon gives the thumbs up to a relative and we stop the tape. While the patient is in post-op recovery, the narrator places the videotape, a coffee mug and post-cataract sunglasses in a bag, which she hand-delivers to the patient.

Our patients enjoy showing off the tapes. Every time they pop in the video, they're helping friends and family understand the advances in outpatient cataract surgery and reduce anxiety about the procedure. Every replay of the video is an endorsement of a surgery center confident enough to send its patients home with an unedited recording of their surgery; in the unlikely event of a complication, narrators would walk the patient and relative through it.

We've surveyed our patients and found that nearly 90 percent of them have VHS machines (we spend $10,000 to $15,000 a year on videotapes) and about 40 percent have DVD players. If the second number continues to grow, we might soon consider upgrading our recording equipment to make DVDs.

James D. Dawes, MHA, CMPE
Chief Administrative Officer
Center for Sight
Venice, Fla.
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What I Like About You
Since the beginning of the year, we've instituted a "warm fuzzy" comments session at each staff meeting. I'll announce beforehand who's going to be the subject of the comments at the meeting. Then we go around the room and each staff member - there are usually 15 or 20 of them in attendance - says something she likes about that person. The first person I picked was the most positive person we have here, so I knew she'd be easy to do and set a good example. After that, it's just been random selection, from discipline to discipline. The comments are the last agenda item at every meeting, so the sessions end on a high note. This little addition has really made a big difference in morale. Happy people are more productive and, most assuredly, more pleasant to work with.

Sherry Hardee, RN
Administrator
The Cookeville Surgery Center
Cookeville, Tenn.
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Imagineering Your Equipment
We've come up with some creative ways to save money when buying our center's equipment. Instead of ordering a $1,000 crash cart from a catalog, for example, we went to a local hardware store, bought a tool cart for about $200, and with the help of a local welder, modified it to hold our resuscitation equipment. Why should you spend that extra $800 - on something that you might need periodically, and with any luck, never - when you could just go to the hardware store?

At our center, the savings didn't end there. We also designed a set of orthopedic weights with the welder's help ($500 savings) and installed in our supply room wire shelving that we bought at Sam's Club instead of through a medical equipment catalog. All told, we've saved close to $5,000 on equipment since we opened last year. As I like to say, "Creativity captures the cash."

Deb Ulmer, MSN
Nurse Manager
Lake Mary Surgery Center
Lake Mary, Fla.
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Recognizing the OR Team
Here's a simple way to give surgical techs and OR nurses a little recognition and improve the response rate on your patient satisfaction surveys in the process. After surgery, we give our patients a bi-pocket folder that contains a discharge summary in one pocket, a sheet of frequently asked anesthesia questions and a little card that asks patients to be on the lookout for an independent survey and to please take the time to let us know how we're doing.

We write, "Thank you for allowing us to participate in your care," on the inside of the folder and ask everyone who cared for that patient to sign her name. This gives your unsung intraoperative staff the chance to connect the way they couldn't in the OR because their faces were hidden by masks, or patients were too sedated or too anxious to notice them. We've found that since we instituted this little touch, more patients have completed our satisfaction surveys - and even mentioned our staff by name.

Frances Faulkner, RN, CLNC
Clinical Coordinator
Lexington Medical Center-Lexington
Lexington, S.C.
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Patient Mug Shots
A few years ago, I began making customized photo mugs for some of my patients to congratulate them on their continued good health. It's a nice way to commemorate a milestone, such as a patient with prior colon cancer who's just passed his five-year follow-up colonoscopy exam.

After the exam but before the patient is escorted to his car, I ask if I can take a digital photo of the patient, seated and giving a thumbs up. I open the photo in my computer's photo-editing software and paste it into a template that includes the photo and a space for text. Then I e-mail the result (I've blurred the patient's face in this example) to a local photo shop that offers to customize white ceramic mugs with your pictures.

I fill the mug with Hershey's Kisses and mail it to the patient along with a note of congratulations. Of course, the patients are pleasantly surprised by this extra effort from their doctor.

If you're Photoshop-savvy and would like to give this a try, I've posted the template at our Web site, www.gihealth.com/mug.psd.

Robert D. Fusco, MD
Medical Director
Three Rivers Endoscopy Center
Moon Township, Pa.
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Patch Prevents PONV
Treating even one patient who's suffering from post-operative nausea or vomiting is too many. In recent months, when our nurses make their pre-op telephone calls the day before surgery, they've been asking patients if they've had surgery before and whether they've been sick afterward.

If so, we ask their physician to call a pharmacy near them to prescribe a scopolamine patch, such as Transderm Scop, so the patient can put it on the night before and wear it to the center the next day. They still get an anti-emetic during surgery. Our patients are ecstatic about it, because they're not getting sick and they don't need a follow-up anti-emetic. They don't have to stay at the center as long and they require less nursing time. All told, we save time and have improved our patient satisfaction rate. We have a standing order with our on-site anesthesiologist so that patients can get the script filled in time for the patch to work.

Rene Conrad, RN
Clinical Director
Grants Pass Surgery Center
Grants Pass, Ore.
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Don't Let Them Go Hungry
Since we opened five years ago, we've had complimentary refreshments around our facility for nurses as well as our patients and their families. Our materials manager buys from a list of what we consider desirable snacks - things that aren't high in fat and offer some nutrition, food that pediatric patients and their parents will eat - during her trips to the store for other supplies.

We budget about $300 a week for the snacks, but it's well worth it. We're out on the edge of the city limits. The nearest eating establishments are a half-mile to a mile away. Sometimes we're quite busy, and staff members don't have the chance to get something for lunch. If someone leaves for lunch, they're gone for hour in the middle of the day, and we can't afford to lose that time. So we put refreshments in the break room.

There's also a basket in the reception area our nurses restock throughout the day: treats from the local bakery, little bags of chips or cookies. It's nicer than a vending machine, especially when patients and their families are stressed. If Mom and Dad haven't had anything to eat, they can have a bite while they're waiting, and when their child's surgery is done, they're energized enough to give the child the care he needs. Even post-operative patients can have a little something. Kids will eat gummy bears when they won't eat anything else.

Becky Chillemi, RN, BSN, CNOR
OR Director
Stillwater Surgery Center
Stillwater, Okla.
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Manipulate Your Schedule
Nobody can afford to have nurses and techs sitting around unused, but that's what you'll get if different physicians have scheduled a lineup of cases that vary in complexity and require different staff members. By carefully looking at the schedule and by mixing it up a little, you can manage it to make more efficient use of your staff.

Let's say you have two ORs scheduled with four hour-long cases each. Each OR has two cases that will need two attending nurses and two more that need three. If you schedule the ORs so that the two-nurse cases coincide with the three-nurse cases, you only need five nurses in any given hour, instead of a situation where you might need four nurses one hour and six the next, then four later.

The nurses are the flexible feature of this concept, possibly moving from room to room, and cross-training plays an important part here, too.

Beth Lizza, RN, CNOR
Director of Nursing
Springfield Surgery Center
Springfield, Ohio
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