No More Telephone Tag
A recorded message easily lets staff know when they're working.

My OR manager used to spend an hour every night calling all 20 OR staff members to let them know what time they were to report the next day. It would take her even longer to leave part-time staff voicemails about their start times. All of this was necessary, or so we thought, because we stagger shifts at our small facility to accommodate our surgeons, who perform cases between 6 a.m. and 4 p.m.

All this changed a year ago thanks to an unlikely source: jury duty. The day before I was to report to the courthouse, I was instructed to call the juror information line. A recorded message told me when and where to report. Then it hit me: Why couldn't we develop a surgery call-in line to inform staff of their next day's start time the evening before. All it took was a dedicated telephone line and a call to our IT person, and the surgery call-in line was born. Staff can call from anywhere at any time to find out when they're working. They'll hear, "Maggie comes in at 8; Gina comes in at 7" and so on.

What used to take our OR manager an hour or more now takes 10 minutes. What's more, staff no longer have to call a shift supervisor to find out what time they're due in the next day. Those calls went like this. "What time do I come in tomorrow?" "I don't know, I'm busy," the supervisor would say. She'd then have to stop what she was doing to look at the time listed on the control board.

Mary Erickson, RN, BSN
Director, Patient Care Services
St. Croix Regional Medical Center
St. Croix Falls, Wisc.
[email protected]

You Can't Outsource Liability
Outsourcing your anesthesia services to an anesthesia management company or to locums doesn't absolve your facility from malpractice risk. Consider these issues when assembling your anesthesia team:

• Choosing an agency. What is the agency's standing in the local healthcare community? Does the agency or locum follow the guidelines of the American Association of Nurse Anesthetists and the American Society of Anesthesiologists?
• Who's responsible for the healthcare personnel? Does the agency verify that its employees' credentials are current and that the physician or nurse has no complaints against them from a licensing board? Can the agency provide documentation of competencies?
• Like a new employee. Remember, an agency physician or nurse enters your facility just like a new employee. They may not be familiar with staff members, equipment, where supplies are located or your facility's policies and procedures. All of these issues contribute to an increased risk of error. Does your facility have an orientation program for subcontractors that includes written policies and procedures, a tour of the facility and evacuation procedures?

Catherine M. Griswold, RN, MSN, CLNC
Founder and President
Health Care Educators & Consultants
Sykesville, Md.
[email protected]

Enlist Patients' Assistance in Pre-op Assessment
To collect H&P information and to give patients pre-surgical instructions via pre-op calls could take 20 minutes each or more, time our smaller ASC can't spare. Our solution: We get patients to give us their pre-op assessments in their words, from their perspectives, before we call them.

At their pre-surgical consultations, patients get a two-page self-assessment form. On the first page, we ask them about their medical history, in user-friendly language that's less clinical than the form we'd have in front of us if we were making the call. We ask about their vital statistics, any past or ongoing conditions or co-morbidities, previous hospitalizations or experiences with anesthesia and even if they have a hearing aid or dentures.

The form explains issues they might not be familiar with: instead of just asking whether they have a latex allergy, it'll ask if they've noticed reactions to adhesive bandages, tape, plastics, avocados or bananas.

On the second page, they fill in the medications they're taking, including over-the-counter drugs, vitamins and supplements, along with dosages and indications.

Patients can either complete the form in their physicians' offices, after which it is faxed over to us, or take it home and mail it to us directly. We then review it and call them. Having the bulk of the information ahead of time lets us focus on any health issues that need specific attention as well as on pre-surgical instructions. This generally takes us about 10 minutes instead of 20 or 30.

While we initially met with resistance from the physicians' offices we distributed our forms through — they assumed it meant more work for them — we ensured them that our aim was to have patients complete the forms. Now, though, we're even considering posting the form on our Web site so that patients can print them out at home and send them to us.

Linda Jenkins, RN, BSN, MSA
Administrator, Truvista Surgery Center
Troy, Mich.
[email protected]

On the Web
Go to www.outpatientsurgery.net/forms to download a patient self-assessment form.

E. coli Coffee? Turn Infection Prevention Education Into a Party
If you can make education fun and interesting, you can capture people's attention. I apply this idea to the infection prevention training sessions at my facility so that our staff learns about the scientific issues and best practices while having a good time.

One of my projects was the Happy Hands Ballet Bar. I decorated the room with pink crepe paper for the dance theme and served drinks such as "Listeriosis Lemonade," "Cranberry Klebsiella" and "E. coli Coffee" to staff. This gave me a chance to meet everyone and hand out the latest infection control papers and pamphlets. I also used this opportunity to quiz staff about our facility's infection prevention practices. Everyone could fill in the answers and then check how well they did against an answer key. When they were done, they wrote their names on the quizzes and submitted them into a raffle box. One lucky winner received a $20 gift card. As for me, the submitted quizzes were my records that our staff received the education and I could tell by the answers they crossed out what sorts of questions they were getting wrong.

By the end of the event, I was able to bring everyone up to speed on our facility's procedures. It was so much fun that, months later, our staff is still talking about it.

Joan Kuenz, RN, MS
Infection Control Nurse and Employee Health Coordinator
Eden Medical Center
San Leandro, Calif.
[email protected]

Accreditation: Go Buy the Book
Our surveyors come every three years, but we don't wait until the survey is scheduled to update our policies and procedures. Every year, we buy an accreditation handbook (ours cost $165) and update our processes to match any new requirements. We also use the handbook as a daily reference, not just at survey time. At our last survey (October 2007), the surveyors told us that the 2008 edition of the handbook would contain a lot of changes.

When I get the new handbook, I assign chapters to staff members to read and ask them to update our corresponding policies and procedures. This helps staff take ownership in how we do business at the surgery center. I also schedule the yearly state Department of Health survey around the same time as the surveyor's visit to take advantage of the fact that everything is readily available for review. Although doing this can be stressful, it's all done in about a week.

Elizabeth Diehl, RN, BSN
Director, Summit Surgery Center
Chambersburg, Pa.
[email protected]