On really busy days - 50-plus procedures, which are a lot for our four ORs and one procedure room - I sometimes treat the staff to breakfast and lunch. In the morning, we'll have something simple like bagels, and for lunch we might have salad, pizza or Chinese and dessert, depending on what the nurses are in the mood for. Because we don't order out each time we have a huge caseload, it's still viewed as a treat, the staff feels rewarded and it engenders staff togetherness. Doing this also lets us stay on schedule: With everyone remaining on site for lunch, we can coordinate break times better. As an added bonus, when doctors in our building find out the nurses are having food, they'll stop by, which enhances communication between physicians and the rest of the staff.

Thomas E. Mulhern, MBA
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A system to stop oxygen leaks
Since most freestanding ASCs depend on in-house H-cylinders for their oxygen supply, any loss or slow leak of oxygen can be costly and even dangerous to patient care. I've found, at several surgery centers over the past 10 years, that assigning someone to do these three simple tasks at the end of the day can significantly reduce oxygen loss:

• Disconnect the oxygen supply to the anesthesia machines.
• Disconnect the wall oxygen regulators in the pre-op and PACU areas.
• Make a quick check of the oxygen closet to check/record the cylinder oxygen pressure/level and inspect the pigtail connectors (often, when changing out a cylinder, the pig-tail connectors to the manifold are loosely reattached, leading to leaks).

Though one might assume that the nursing staff would be in charge of this, the responsibility can rest with anyone; in fact, I did it for years at a facility where I was the chief of anesthesia and medical director. Ideally, in an organized and integrated facility, anyone could check-disconnect-reconnect the oxygen flow meters - housekeeping, anesthesia or nursing staff.

These tasks, and the simple reconnection of the anesthesia machines and wall regulators the next workday morning, should prove cost-efficient and provide necessary peace of mind of an uninterrupted oxygen supply.

Adam F. Dorin, MD, MBA
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Make pre-op no-no's clear
We give our patients lists of medications and herbal supplements they should not take before their surgeries. The list also tells patients when to stop taking the medications and supplements (for example, 48 hours before surgery, one week before surgery). But to make it stand out from the rest of the pre-operative information and documentation we give to patients, such as surgery-day instructions and HIPAA notices, we run off copies of the list on brightly colored sheets of paper. In addition, we list brand names (Motrin and Advil) rather than simply telling patients not to take ibuprofen.

Susan Anello, RN

Consider heparin locks instead of an IV
We converted to using heparin locks instead of an IV on outpatient ophthalmic patients. The cost of a heparin lock and an IV catheter are not that different; but the cost of tubing and IV solution make using an IV more expensive. Thus, by converting to heparin locks, we've cut cost without losing the quality of care.

Dea Switch, RN, MS
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Take a break from being boss
We have a lot of cross-trained employees, and our office staff is especially versatile. In fact, our receptionist is also our credentialing clerk. She takes one day each month to do the credentialing files, and I fill in for her. Not only does this save me the cost of hiring someone per diem to do the job, but it gives our receptionist more job satisfaction because she's doing something different. In addition, staff and patients love to see "the boss" at the front desk.

Christy Therrien, RN
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Stop wasting endopouch bags
We used to open an endopouch bag when preparing for every laparoscopic cholecystectomy, but of course it wasn't always used - and we would have to throw it away because it was no longer sterile. To save money and reduce waste, we now have an endopouch bag in the room, but do not open it until the surgeon asks for it.

Pam Moss, RN, MICN, ACLS, PALS, BTLS
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