In this world nothing is certain but death and taxes — and late-arriving surgeons. Here's advice for improving your on-time starts.

1. Wake-up calls. Your tardy surgeons might get the message if you give them wake-up calls. "If the telephone goes unanswered, use the cell phone," says anesthesiologist Mary Craddock, MD, CASC, of the Friendship Ambulatory Surgery Center in Chevy Chase, Md. "Call repeatedly. Call their answering service." Dr. Craddock says that this strategy worked. "Our physicians now arrive on time and all is well," she says. Another facility pages doctors who aren't in pre-op to mark the patient 5 minutes after the scheduled start time.

2. Post offenders' names. Blessing Hospital in Quincy, Ill., has a no-tolerance policy for tardy surgeons. It posts the names of late surgeons in the surgeons' lounge. Surgeons who are late twice in 1 quarter are in jeopardy of losing their blocks. All surgeons are required to be in the OR, checked in by the OR desk, 15 minutes before cases start, says Lori Fecht, RNFA, the director of perioperative services.

3. "Punish" repeat offenders. Physicians who are chronically late for the first start of the day at the Surgicenter of Kansas City (Mo.) get a warning letter after 6 offenses. After 12 tardies, they're required to buy lunch for the entire facility, says Medical Director Jon Cromer, MD. "Our original policy was to levy a $100 late fee after the 12th offense, but our medical review board committee thought being forced to buy lunch for the staff had a little more teeth as a punishment and deterrent," says Dr. Cromer.

The official policy at the Surgery Center of Chester County in Exton, Pa., states that surgeons who are late more than 3 times in 2 months may have privileges suspended for 14 days. "But you know that's not going to happen," says Manager Lorraine Gambol. "It hasn't happened in the 6 years I've been here." A few other centers report fining surgeons for every minute they're late.

4. Document first-case arrival. Have the surgeons and anesthesia providers swipe in, electronically sign in or in some other manner collect what time they are in the facility for the morning's first case, says Stuart Katz, FACHE, MBA, CASC, the executive director of the Tucson (Ariz.) Ortho-paedic Surgery Center. If your first case of the day is at 7:30 a.m., you want the patient in the facility by 6:30 a.m. and in pre-op no later than 6:50 a.m., the surgeon in the facility by 7:20 a.m. and anesthesia there in enough time to have the patient in the room by 7:30 a.m., says Mr. Katz.

— Dan O'Connor