Facility fees for endoscopy are generally on the low end, so one of the keys to being financially successful with these procedures is to do a healthy volume of cases in a highly efficient manner. Over our seven-year history as a single-specialty endoscopy lab, we've learned some "tricks" that have helped us ramp up to 750 cases per month in our three-procedure room center, and at the same time improve patient satisfaction and retain AAAHC accreditation. Possibly some of the things we learned will help you too.

Design for efficiency
Our first facility, which we built in 1995, incorporated several design flaws that inhibited efficiency. For one thing, our admitting room also served as our recovery room, and we only had five beds. More than once, all five beds were filled, forcing us to hold up admissions until a bed opened up. For another, our decontamination and disinfection area was unconnected to the ORs, so that staff had to carry scopes out of the procedure room, through the common area (in full view of the patients) and into the decontamination room.

Our new facility, which we opened last year, has three procedure rooms. Our admitting and recovery rooms are separate, and we have a total of eight beds, three of which are designated as "swing" beds, meaning we can use them where and when we need them.

Our new decontamination room is located between two of the procedure rooms, and there are swinging-door entrances from both procedure rooms. As a result our employees can get the scopes into decontamination much faster and much more discreetly. When we designed the facility, we envisioned the third room as an "overflow" room, but now we are using it every day. If we had it to do over again, we might have tried harder to find a way to also adjoin that room to the decontamination/disinfection room.

Our new facility also has a much more open feel, which we find helps our staff members work together better as a team. There is also a centralized nursing desk that allows our staff to see all areas in the facility and quickly react to call lights or staff requests for assistance.

Use highly specific scheduling.
We keep our staff, physicians and patients on very strict schedules, which helps us stay on time, reduce labor costs, and increase the satisfaction of patients and their families. Here are some of our techniques:

Staff scheduling. We give each of our have 17 full-time and three part-time clinical staff members very detailed and specific schedules. The schedules specify all of the employees' duties and break periods. We stagger breaks and lunch periods so that we can see patients continuously throughout the day.

Incidentally, to help head off staff "burnout," we rotate the duties so that no one is in the same position each day. For example, an RN may work in Post Anesthesia Recovery in the morning, take a lunch break, and then work the remainder of the day in the procedure room.

Physician scheduling. Offering block time is a key to attracting and keeping physicians. However, it can also cause major inefficiencies if a physician doesn't use the time.

We initially allotted our block time based on seniority, and we still try to take personal preferences into account as much as possible. However, we allow physicians to retain block time only if they use it fully. We review the usage quarterly. If physicians do not use their block time, we assign it to a physician with better utilization.

Patient Scheduling. We schedule procedures every 30 minutes. However, we schedule patient arrivals every 15 minutes. This way, instead of having to check in, admit and prep three patients at a time, our staff handles no more than two patients at any one time. This helps the staff accomplish their tasks in a more orderly fashion, and it also improves patient satisfaction, since it essentially reduces waiting time.

We realize that the person escorting the patient may be busy, and we act accordingly. We make sure to inform the patients' escorts about any delays; if they choose to leave the facility, we provide them with a beeper so we can contact them when the patient is ready to leave.

Do Away with Dictation
Three years ago, we were doing dictation in the usual fashion; physicians would say their op notes into a tape recorder, we would send the tapes to a transcriptionist, and the records would arrive in three or four days.

This slowed down our billing and inhibited doctor-patient communication as well, since our physicians had no diagrams to "show and tell" the patient what they found and no operative report for them to review and to give to their family physician.

That all changed when we bought the CMore system, which has since been renamed the Provation system. This system helps the doctor do his op-notes and associate actual images with where the polyps are via a "branching menu" interface. It's easy to use, and it automatically adds the CPT codes. The system prints the report along with the patient's discharge instructions and letters to their referring physician while the patient is still in the recovery room, and the coding information is transmitted electronically to our billing company at the end of the day.

Use Savvy Staffing
The staff of any surgery facility is a big key to its success, and yet hiring and keeping stable, motivated, performance-oriented staff members is harder than ever these days due to the nursing shortage. Here are a few techniques that have helped us:

Use unlicensed as well as licensed personnel: In addition to our 12 registered nurses, we employ seven medical assistants. They are all graduates of an accredited medical assistant program and have been working in the medical field for at least two years. Most are ACLS certified as well. When we first hire MAs, we train them in every area of the facility (instrument reprocessing, admitting, floating) before training them to assist with procedures. When they are ready to assist with cases, a CGRN and the physicians provide hands-on training in the procedure rooms. We mandate that the MAs pass the same conscious sedation exam that the RNs take. In the procedure room, the physician as well as the circulating RN supervises the MA. The RN is directly responsible for the medical assistant and co-signs all documentation, including chart notes made by the MA.

Keep in mind that the laws of Washington State permit us to use MAs in this manner; check your state laws before trying this.

Cross training: We encourage our staff to learn about all areas of the center. We have found that our staffers are eager to learn, that they like "mentoring" each other, and that this decreases staff burnout and allows us to be much more flexible in our daily staffing assignments.

We give all new staff members a detailed training schedule with a specific skill or area for each day. We also provide study packets and quizzes on various topics such as latex allergy and conscious sedation. Employees must review the materials and pass an exam with a score above 75 percent. Only when the employee has completed our competency checklist and has told us that she is confident that she can handle the task do we assign it to her.

Recognition and incentives: To attract and retain the best staff and foster teamwork, we provide an incentive program, keep wages competitive, and encourage team-building opportunities outside of the workplace, such as picnics and holiday parties. We also provide educational opportunities (full tuition and board at local and national conferences). We try to get our staff involved in the facility and ask for their input on decisions. But most of all we recognize outstanding teamwork and employee performance and reward it! We recognize employees with our "You Made My Day" certificates and present them with the certificate and a gift in front of their peers. We''e found the American Express or Nordstrom gift certificates are very popular with our staff.

We also have an incentive program that rewards employees