With only one OR in our ASC and a caseload of 375 to 400 chronic pain patients per month, maintaining high patient-satisfaction scores requires a top-to-bottom team effort. Our patients are only satisfied when their pain quiets down and their ability to perform the activities of daily living goes up. And naturally, they want to be treated with dignity and respect throughout the process.
Our surgery center is one part of a collaborative team that also includes a rehabilitation and occupational therapy department and clinical psychologists. That multidisciplinary approach is one of the keys to our success.?
Our facility offers epidural steroid injections, transforaminal steroid injections, medial branch blocks, radiofrequency ablations, various nerve blocks, spinal cord stimulator trials, discography and kyphoplasty, so we can tailor treatment to individual needs and ensure the best possible outcomes. Here are the key components that let us consistently function at the highest level:
- Managing expectations. Our clinical psychologists help make sure patients have appropriate expectations, based on their pain conditions. They also perform risk assessments for all patients before we prescribe any pain medications.
- Tailoring treatments. To determine which procedure is appropriate, one of our 9 family nurse practitioners performs a detailed and thorough physical exam, in conjunction with our physicians. Our procedures are very specific, depending on the type of pain, its location, whether the pain radiates to other areas, and several other considerations. Additionally, many of our patients are referred by neurosurgeons or orthopedic surgeons who suggest what they think their patients need.
- Quick preparation. Our pre-op area has 4 patient bays and our staff works quickly to get patients ready. Typically we have 2 or 3 nurses in this area.
- Super-fast turnover. With only one OR, quick and safe turnover is essential. On a normal day, we can do between 5 and 9 procedures per hour, including some that require sedation. But this rate of turnover is only possible if all of our team members work together to get the job done. So each person has a specific assigned duty. For example, our radiology technician cleans the room, helps the patient to the OR table, and secures the safety straps across the patient. Our surgical tech prepares the case and pulls the next patient's record up to prepare for the time out. Our CRNA and one of our 2 patient attendants bring the next patient into the OR suite. The bottom line: Rapid turnover requires extra staffing, but it pays off. We rarely need more than 2 or 3 minutes to get ready for the next patient.
A few words about our patient attendants: They're vital cogs when it comes to keeping the schedule on track. They take care of many tasks, which increases the amount of time nurses are able to spend taking care of patients. The 2 most helpful duties (in addition to helping CRNAs transport patients to the OR) are helping patients get dressed after their procedures and transporting them in wheelchairs to their cars. But they also do a little bit of everything else, including cleaning, moving stretchers and stocking supplies. Without them, our turnover and efficiency would be severely diminished.
- C-arm specialist. Because all of our cases are performed under fluoroscopy, having an experienced radiology technician who's well trained in anatomy is also a crucial element in helping to shorten procedure times. This is especially important when you do a high volume of cases, because every minute counts. Our RT has the C-arm set in the correct position to begin each procedure and is able to anticipate every move the physician makes, ultimately saving a minute or two each case. When you perform as many as 30-plus cases per day, that savings adds up quickly.
- Efficient discharge. Our PACU is usually staffed with 2 nurses and, like our pre-op, is equipped with 4 patient bays. Because our patients receive only local or light-to-moderate sedation, we're able to discharge patients safely and quickly.
- EMR success. When we planned our ASC, we decided to invest in an EMR. That decision has proven to be a wise one. The EMR has proven to be a major factor in our success. The EMR provides immediate access to previous patient visits, which is helpful in our specialty, as our patients often have had multiple procedures and visits. It also lets our anesthesia care provider view previous levels of sedation and how the patient responded to each. Further, in the OR, vital signs are automatically downloaded into the anesthesia record from the patient monitor. That lets our anesthetist focus on other important tasks during the procedure. Also, medication lists are easily updated and carried over from each patient encounter.
- Strategic scheduling. Knowing when to schedule certain patients also helps keep us on track during high-volume days. Performing our SCS trials, discographies, and kyphoplasties at the beginning of the day works better for us, allowing for a better flow once our quicker cases begin.
- The right atmosphere. We strive to make sure our facility is not only clean, but also cheerful and well-maintained. Those are important components in how patients perceive their care. No one wants to have a procedure done in a place that's cluttered or dull.
At the end of the day
Ultimately, everyone has an important role the business office, the receptionist, the nursing staff, the CRNA, the patient attendants, the OR staff and, most importantly, our physicians. Patients are comfortable and satisfied because our staff is friendly, compassionate, competent, and full of smiles. Our positive attitudes, efficient workflow and effective treatments help ease their pain and improve their outlook, so our patients end up smiling, too.