Of all the feats regularly accomplished at an ASC, scheduling has to be among the most amazing. We thought it would be enlightening to ask professionals in three different roles to share their views on how the process works – and the challenges therein.
The Clinical Director
Barbara Sininger, RN, BSN, is clinical director at The Knightsbridge Surgery Center in Columbus, Ohio. It opened its doors in 2001 and features three ORs plus a combination treatment room/OR. Its multi-specialties include urology, general surgery, GI, plastics, gynecology, neurology and pain management. There are 20 full-time staff, 17 per diem and approximately 4,000 cases per year.
My own understanding of scheduling involves 1. a committed, mature and flexible scheduler who can accommodate the demands of offices, physicians and patients and work closely with the administration, and 2. a scheduler who has a clear understanding of equipment and personnel needs for each case.
I believe one of the major challenges we face in scheduling is making a complicated process accessible for offices and patients. A lot of work needs to be done at the front end so that when patients arrive at the facility, all our 'ducks are in a row.' Physicians and patients don’t want to know about all the time and effort that has been done on their behalf so that the surgical experience runs safely and efficiently. They just want a safe and efficient experience.
A good scheduler is a great facilitator. One of the things we try to do to make our schedule more efficient is to release block time a week before the date if the block is not being utilized. This allows other physicians to schedule at a time that might not have been initially available. We try very hard to consolidate rooms so there is not one case in one room for one hour. Our physician offices are a great help in managing those days and will, at times, move a physician's schedule around in order to accommodate our needs. It is a great asset to be able to utilize per diem staff. They will come in late, leave early or many times just come in to help get us through lunches. This helps us schedule rooms efficiently.
A collaborative relationship between physician offices and the facility scheduler is a must. “Let me see what I can do for you" is a much better approach than a simple, “Sorry, but Dr. ABC has that time." If the facility scheduler has a good working relationship with Dr. ABC's scheduler, we can usually rearrange for both cases to get on the schedule.
Lisa Kelley, RN, MBA, CHCRM, is administrator of Summerlin Bend Surgery Center dba Adult & Children’s Surgery Center of Southwest Florida in Fort Myers, Fla. Opened in 2000, the center features two OR suites with specialties of orthopedic (adult and pediatric), neurosurgery, ENT (adult and pediatric) and podiatry. There are 25 physician partners, 30 on medical staff and 20 employees, with approximately 160 cases per month.
The scheduling process is all-inclusive. It starts with the schedulers – the ASC's and the surgeons' – working out conflicts with their surgeon partners as their block time is shared. The surgeons are very flexible in trying to schedule their cases – as long as it is reasonable for all. The ASC staff must be sensitive to this issue. If there is conflict, the buck stops with management (either the administrator or clinical manager) to work out the kinks directly with the surgeons.
The next phase of the scheduling challenge is how to sequence patients so that we have the necessary supplies, staff and instrument trays available and do not cause delays. This aspect requires close communication with the clinical manager and the lead scrub tech to assure we have proper availability for the scheduled cases.
Continuing on with the process – the pre-op screening – which starts immediately after the case is booked. Patients complete an online account of their medical history. An RN will assess and discuss the pertinent issues with each patient. If something questionable is found, our anesthesiologist is involved to assure the patient is appropriate for the ASC setting. Each patient is evaluated by the anesthesiologist once they are admitted.