Arthroscopies aren't lengthy or complex, but if your facility regularly hosts a full slate of them, staying on schedule is best for the bottom line. You've probably already cross-trained to make sure you always have skilled staff on hand, standardized your procedure packs for economy and convenience, and grouped all your left-side and right-side cases to avoid redundant repositioning. Here's what else some high-volume centers have done to take arthroscopy efficiency to the next level.

Tower technology
Your purchasing decision for video imaging technology often comes down to physician preference. There may be multiple advantages in getting as many specialties as possible on board with the choice.

"If you can, equip your OR with a universal video tower system, not 1 ortho tower and 1 general tower," says Hugh Cornelson, RN, a circulating nurse at Gainesville (Ga.) Surgery Center. This option will let your staff train on and become adept at a single system, he says. "The more simple it is for them to set up, the better for everybody." There are also budgetary benefits to be gained from consolidating into multi-purpose technology.

If you're upgrading your equipment, keep media in mind, too. "Older towers have printers, but newer ones record photos to CDs or thumb drives, or can wirelessly send them," says Mike Pankey, RN, MBA, administrator of the ASC of Spartanburg (S.C.), which will shave time from the process. Make sure you enlist your IT experts to keep networked images secure.

"The first step toward arthroscopy efficiency is having a good staff that knows the equipment in the room," says Chuck Strasser, RN, executive director of Allied Physicians Surgery Center in South Bend, Ind. Having a dedicated video equipment technician stands to make a good staff even better. His center contracts with the tower's manufacturer for an on-site tech who readies cameras and scopes for each case, troubleshoots errors, changes printer paper and ink, cleans and resets components during room turnovers and frees up nurses and techs to focus on patient care.

SPEEDY SUCTION A continuous fluid waste collection system can keep room turnovers short.

Prime pumps
Arthroscopy pumps aren't as flashy as video technology, but they're just as important to surgical visualization. "They keep the field of vision clear," says Mr. Cornelson. "Without them, you're looking at a bloody joint and not able to do anything."

Some pumps offer additional advantages. "What makes ours nice is it has an external remote, so the tech or physician can operate it directly from the field," says Mr. Cornelson. "Otherwise, they'd have to call the circulator over to increase the pressure or turn up the outflow."

Mr. Pankey notes that pumps are also available with extension tubing, backflow prevention and sterile capping methods that allow you to use them from case to case, uncontaminated, without having to spike a new bag of saline (if there's some left from the last case) or feed new tubing through, which can save both time and money.

Turnover tips
Shoulder arthroscopies tend to take an hour, maybe an hour and 20 minutes. Knee scopes are usually only 30 to 45 minutes. According to our panel of experts, however, what goes on between cases makes much of the difference with regard to efficiency.

Pulling supplies for the next day's schedule at the end of the day can speed the process, says Louise DeChesser, RN, CNOR, MS, administrator of the Middlesex Center for Advanced Orthopedic Surgery in Middletown, Conn. "We have all the supplies picked and bagged on a cart. While the room is being mopped, the circulator just goes out and grabs the bag."

Remember, too, to stock a solid supply of fluid, says Mr. Cornelson. "These cases use a high volume, so you'll always want to have plenty of saline in the room," he says. "There are other things to do beside watching the pump," of course, but when you need to replace the bag, an adequate supply means you can handle the change quickly and not delay the case for a run down the hall.

Mr. Pankey maintains that an efficient arthroscopy schedule is predicated on an investment in extra scopes, components and instrument trays, since reprocessing according to manufacturers' directions takes time and immediate-use flashing shouldn't be a routine practice. "Get enough trays, at least 1, or possibly 2, per case on your schedule," he says. "If you're not able to, if your budget doesn't allow it, you can intermingle smaller cases in between that don't require a lot of space and don't require you to move all the equipment out of the room," such as hand, hardware removal or ORIF ankle cases.

Make sure that your post-case cleanup isn't a drag on your schedule. Given the volume of fluid that arthroscopies go through, a high-capacity, closed-suction, fluid waste management system is a must. "We try to limit our turnovers to 10 minutes, so fluid collection is important during procedures," says Mr. Cornelson. "Putting down and picking up towels throughout a case is not terribly economical, plus there's an exposure risk to blood and body fluids, and you have to pick up the towels before you can mop." With a continuous suction device, "the floor is essentially dry. You just take the trash out, mop and you're ready to go."

Also, don't wait longer than you have to on chemical action, says Mr. Pankey. "We use a surface disinfectant with a 1-minute microbial kill time," he says. "We don't want to stand there waiting 10 minutes, keeping it wet for a complete kill."

People are the process
In the overview, improving your efficiency in a schedule of cases doesn't necessarily require an investment in equipment, as much as the involvement of your people, says Ms. DeChesser.

"Listen to your staff. Engage all your team members to look for efficiencies. They're scrubbing in all the time, they see what can be done," she says. "That 3 or 4 or 5 minutes here and there, at the end of the day, equals 1 case, and your efficiency will cost you less overtime. You forget, but those few minutes are precious."