Hospital OR Manager

Working on the Weekend
Hospital Explores Saturday, Sunday Surgeries to Improve Case Capacity
As opposed to the no-nights and no-weekends mentality of ASC staffs, hospital workers have always differed in their willingness to work off-peak hours. That willingness may soon be tested at Lankenau Hospital in Wynnewood, Pa., where administrators are looking into expanding their elective surgery schedule to include weekends.

Starting this month, elective Caesarean sections will be performed on the weekends at Lankenau. Other specialties are considering making the weekend plunge, including orthopedic surgery, plastic surgery and urology departments. The hospital has polled its surgeons, and about one-third expressed an interest in expanding their surgery schedules.

A hospital task force is working to determine the true feasibility of expanded surgery hours; Lankenau's support staff obviously has to buy into the idea for it to be successful.

"Change is hard," says hospital president Gail Egan. "But this is a definite go in my mind. I'm not going to waste my time with those surgeons who don't want to be involved. I'm going to invest my time with those who are interested. Operating on the weekends is good for business."

Ms. Egan sights several potentials for believing in weekend surgery: freeing up beds in the hospital during the week; enabling her facility to grow by increasing case capacity; and an ability to accommodate a growing desire of patients to avoid missing work by undergoing elective surgical procedures on the weekend.

"From a practical standpoint, we need to make Saturday look like Tuesday and Sunday look like Monday," says Ms. Egan.

Billing in Advance
Is a Pre-pay Program Right for You?
In an effort to reduce bad debt and curb unpaid fees, Marshall Hospital of Placerville, Calif., is among a growing number of hospitals asking patients to pre-pay bills for any scheduled elective hospital or outpatient treatment.

Marshall Hospital's bad debt has totaled $4 million annually; a figure Karen Dostart, business services manager at Marshall Medical Health System, hopes to cut in half within a year. The bad debt issue is hardly unique to Marshall Hospital. According to the latest figures from the American Hospital Association, uncompensated hospital care nationwide swelled to $22.3 billion in 2002, a 52 percent increase from $14.7 billion in 1992.

That eye-popping increase has drawn the attention of several national hospital management firms, including Tenet Healthcare Corporation. Tenet, owner and operator of 96 acute-care hospitals, is also instituting a pre-pay policy to tighten up its accounts receivable and improve cash flow.

"The policy has been well received," says Steven Campanini, a Tenet spokesman. "It provides a structure for our facilities to collect fees and reduce overall bad debt." And a reduction in bad debt, Mr. Campanini claims, will help combat the broader problem of rising healthcare costs - costs that are passed on to healthcare employees and patients in the form of higher benefit fees and co-payments.

Online Registration
How E-patient Registration Improves Pre-admin Efficiency
Hospitals in the Baptist Memorial Health Care system have harnessed the Internet to streamline the pre-administration process. Baptist offers e-patient registration for all scheduled services. Here's how it works. Patients are able to go online, enter their appointment date and time, physician's name and procedure they'll undergo. The service eliminates the need for patients to bring personal information on the day of their surgery.

"Anytime you can get information prior to arrival, the whole visit is easier on the patient," says Liz Tucker, system director of access operations for Baptist Memorial Healthcare. She also points out an added benefit of online registration that is unique to hospital ORs. "As management, the completion of a scheduled patient's records allows us more time to deal with walk-in and emergency cases."

Whether you already take advantage of an e-patient registration process or you're thinking of launching a site, consider some lessons learned by Baptist.

• Get the word out. Making patients conscious of the online registration process continues to be Baptist's biggest challenge. "They key is in the marketing," says Ms. Tucker. "We need to make the patient population aware of the convenience of registering from the comfort of their homes." As part of its marketing campaign, Baptist places table-tents in physician offices and prints the online registration address at the bottom of appointment cards so patients have an in-hand reminder of the service.
• Remember the users. Incorporate as many tables (click-on answer choices) as possible instead of fill-in sections. The less a patient has to type, the more likely he is to use the service.
• Test the site. Baptist set up a pilot site for six months before rolling out the online registration process for public use. "The test site was essential for working out the bugs, refining the wording and ensuring the site was providing the level of user-friendliness we desired," says Judy Cristlip, director of admissions at Baptist Memorial Hospital for Women in Memphis, Tenn. "We wanted to make it a very visible and very simple site to use."
• Provide direction. Online registration reduces, but does not eliminate, a patient's responsibilities on the day of surgery. Language on the site must be clear in indicating the patient still needs to check-in at the registration location when entering your facility. Also remember to provide directions to your center; making sure a patient knows where he's going is an essential part of the pre-administration process.

Response to Baptist's e-patient registration has been extremely positive. Patients like the fact that they are not limited to daytime hours for registration and can register on their own time instead of frantically searching for personal information when receiving a pre-admission call from a facility.

Surgical Technology
Futuristic OR Improves MIS Program
Children's Hospital of Pittsburgh's high-tech OR has more than tripled its minimally invasive surgery (MIS) throughput. Children's MIS program can now do six procedures to eight procedures a day instead of three to four. The hospital is on pace to perform close to 800 surgeries this year, up from 276 in 2000.

The spacious new room is equipped with flat screens to clearly view the action of the surgeries, moveable ceiling booms to keep the floor clear of equipment, a computerized workstation allowing complete control of the room's technology and wiring for transmitting surgical images to specialists around the country.

Bells and whistles make for great press, but the benefits of the new OR go far beyond aesthetic improvements. Thanks to the organization of the room's equipment, case turnover time has been cut in half - from 30 minutes to 15 minutes. The new technology also means less opportunity for human error, and nurses spend more time on patient care instead of pushing equipment carts around the OR.

Plus, says Timothy Kane, MD, director of minimally invasive surgery at Children's, patients are beginning to expect the best. "The OR has increased our hospital's ability to recruit new patients," he says. "If we didn't offer the new technology, patients would go to other places that did."

For that reason, he believes a common apprehension to investing in new technology is unfounded. "The technology pays for itself in the short term. You have to stay on the cutting edge, or you'll quickly find your program behind the eight ball."

	By Daniel Cook For kids injured playing sports, a new clinic at Children's Hospital Oakland is treating their injuries and getting them back on the field more quickly. The Sports Medicine Center for Young Athletes is the first pediatric clinic for sports injuries in Northern California. The division of the hospital's pediatric orthopedic surgery department evaluates, treats and rehabilitates children and teens with sports injuries. It also develops injury-prevention programs specifically for kids, whose growing bones and cartilage are more susceptible to injuries. ... Imagine improving patient safety and shaving $300,000 off your annual staff injury costs. Memorial Medical Center in Modesto, Calif., did just that by buying equipment designed for lifting and transporting severely obese patients. Hospital officials discovered lifting accidents to be the leading cause of injury to the facility's staff. Instead of living with inflated workers' compensation bills, they made a preemptive investment, buying friction reducing transfer devices - Beasy Boards, Air Pals and disposable Z-Sliders - as well as Sit to Stand and Total Body lifts. The purchase was indicative of a nationwide movement by healthcare facilities to accommodate a rising rate of obesity admissions and an increase in bariatric surgery cases. ... Nationally, the average hospital charge is 232 percent over costs, according to a study of medical bills and health insurance by the California Nurses Association. The group analyzed hospital charges and costs in every state, Washington, D.C., and two U.S. territories. Among the highest charges in the country are in New Jersey, where hospitals charge 415 percent over costs. Among the lowest charges are in South Dakota, where the average hospital charges 148 percent over costs, the report said.

Strange But True
One of the most bizarre cases that I was ever involved with was a patient who had a gastro-intestinal obstruction. The source of the obstruction was quickly determined to be a massive trichobezoar that had taken on a textbook shape of the stomach. I subsequently learned that the patient had a habit of eating his own hair - we took out several years of growth that day.

Bruce Grendell, RN, BSN, MPH
Administrative Director
Surgical Services
Scripps Green Hospital
La Jolla, Calif.

Can you contribute a funny quote or a strange but true tale? If so, please e-mail associate editor Daniel Cook at writeMail("[email protected]").