As an orthopedic ASC with precious little storage space, one of our biggest challenges was lugging 3,000cc bags of irrigation fluid from the sterile room to the OR across the hall. Not only was this an inefficient use of our circulator's time, but also we were concerned from an infection control standpoint about the OR door swinging open so often. It was a chore until one of our staff members hit upon the perfect solution: an Igloo cooler on wheels.

As you can see from the picture, the cooler doesn't take up much OR space (we store it behind the fluid cart) and it holds about 18 3,000cc bags, plenty for an ACL or any other high-fluid-volume procedure. We fill the cooler with the seven-pound bags before the first day's cases. Whenever we need more fluid, the circulator simply reaches down into the cooler, pulls out what she needs and hangs the bags.

Karen Bennett, RN, ONC
ASC Manager
Academy Orthopedics ASC
Cumming, Ga.
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Self-scheduling for Surgeons
Tired of constant complaints about the schedule in our three endoscopy rooms, we now allocate a block of time to a physicians group rather than to a doctor and let the doctors in that group divide it up amongst themselves. It's essentially block scheduling, but it frees my staff from conflict. Scheduling by group is working so well that I'm considering applying it to our minor surgery schedule.

Kim Donnelly, BSN
Clinical Manager
Trinity Health Systems
Steubenville, Ohio
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Encourage Staff Certification
When your OR nurses are CNORs, your PACU nurses are CPANs and your instrument techs are CSPTs, it impresses the patients you serve, the surgeons who bring their cases to your facility and the accreditors who survey you. One way we incentivize our staff to become certified is financial. Staff earn a $1,000 bonus for certification. The other way is recognition. We congratulate newly certified staff in meetings and we're planning to hang a plaque in the waiting room so that patients can see how many of our staff have excelled. We've gone from having 20 percent of our staff certified last year to 80 percent today. As for me? I'm studying for my CASC exam.

Lynn Truitt, MSN, CNOR
Director and Chief Operating Officer
First State Surgery Center
Newark, Del.
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Coordinate Delivery, Shelving of Supplies
Our supply deliveries have tended to arrive late in the afternoon, when most everyone's either gone home or is busy wrapping up surgery, cleaning and preparing for the next day. So by that time, no one's been available to unpack and shelve that day's deliveries. Compounding the problem was a storage room so user-unfriendly that the deliveryman left the boxes in the hall, where they'd sit until someone had the time to tend to them.

When we undertook a renovation project earlier this year, we organized the storage room more efficiently and developed a system for stocking supplies. We've instructed our drivers to drop off any deliveries at a certain place in our storage room, and we made a cardboard sign that says "New deliveries" for them to post when they do. Some staff have taken on the responsibility to stay until the end of the day to unpack and stock any supplies that arrive. They've rearranged their schedule to work four 10-hour shifts, which is their perk for shouldering the task.

When supplies get put away in a timely manner, you not only avoid waiting for urgently needed items to be unpacked, but also keep your par levels even. The purchasing staff can clearly see what we have on hand, instead of thinking we're running out of something that we just haven't shelved yet.

Lisa Hicks, RN, BSN
Clinical Director
Iredell Surgical Center
Statesville, N.C.
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Working Four 10-hour Shifts
About a year ago, some of our nurses asked if it would be possible to work 10-hour shifts, four days a week. We gave it a try. The first thing we had to look at was, on that fifth day, the one they had off, did we have adequate coverage? And how could we manipulate the schedule to provide adequate coverage? You have to make sure you have enough nurses for the number of patients you're going to have coming through your facility, and I always pair a full-time nurse with a per diem.

Once we had the schedule, we found the 10-hour shifts worked to our advantage. We could have late coverage to 5:30 p.m. if we needed it, without overtime, which we'd been trying to reduce. I've even hired a new OR nurse into 10-hour shifts. She saw the other nurses' schedules and asked if she could do that, too. I was all for it. One-fourth of our full-time staff, four out of 16 nurses, work 10-hour shifts at present. I'd like to get more of my staff to do it. They can't all have Friday or Monday off, but I think everybody would enjoy the extra day off, and the daily schedule would benefit.

Karen Gabbert, BSN
Clinical Director
Surgery Center of Kansas
Wichita, Kans.
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Send Patients Home with Get-well Cards
We put a get-well card in a plastic sleeve on the front of each patient's chart. Everyone who participated in the procedure signs it. Then we slip the card into the discharge envelope, along with the patient's discharge instructions, prescriptions, emergency information and other paperwork. Patients don't even know that the card is there until they get home. It's working out well: We've been getting many more letters and comments from patients complimenting by name the staff members who treated them.

In addition, we send each of our pediatric patients home with a Polaroid picture of him in a brightly colored, magnetic frame. Before their surgery, when they've changed into their hospital gown or pajamas and they're in our pediatric playroom, our volunteers ask if they'd like to have their picture taken. They can wear their surgical cap and do whatever they feel they want to do. For us, it's a way to try to make this experience less scary.

The cost of the cards, the frames and the film isn't that much - we get them through our purchasing contracts to keep costs down - and it's a low-budget way to put a happy face on the experience.

Donna Keehner Nowak, RN, MSN
Assistant Director of Nursing
Stony Brook University Hospital ASC
Stony Brook, N.Y.
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No More Day-of-surgery Cancellations
To avoid cancelled procedures on the day of surgery, we created a position for a pre-operative coordinator, a staff member whose exclusive responsibility is to conduct pre-procedure patient interviews. We dedicated an RN from our own ranks to interview patients two days to two weeks ahead of time and work side-by-side with the anesthesiologist regarding any concerns she may have related to the information she gathers during the interview. In addition, she serves as a liaison to physicians' offices so they know exactly whom to call with any questions concerning the patient's pre-procedure.

It's important that an RN do the interviewing, so she can go a step further with the questions to deliver and obtain a complete picture for patient care and safety. For this full-time position, you'll want someone who can be friendly enough that patients feel comfortable telling them the truth, but experienced enough to evaluate their answers.

The expense associated with creating a new position is minimal when compared with the lost revenue from cancellations on the day of the procedures. We haven't cancelled a patient due to incomplete tests or late discoveries in the seven years since we hired our pre-operative coordinator.

Leanne Bales, RN, CNOR
Administrator
Effingham Ambulatory Surgery Center
Effingham, Ill.
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Spend 37? on Patient Satisfaction
Like most ASCs, we send our patients home with a patient satisfaction survey attached to their post-op instructions. We've made it pretty straightforward, yes-and-no questions with space for comments on how we're doing and what we could improve. To make it as easy as possible, we've gone one step further and included a self-addressed, stamped envelope. Now they don't have to do anything but drop it in the mailbox. It sounds so basic, but it's increased our response rate to 85 percent. That's pretty good, considering other facilities' managers have told us that their response rates are generally 50 percent and less.

Terry Merriman, RN, BSN
Clinical Director
Orthopaedic Surgical Center of the North Shore
Peabody, Mass.
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