When it comes to cataract surgery, ambulatory surgery centers generally are a lot more efficient than hospitals. But it doesn't have to stay that way. We have found that the surgical team at our two-room ASC can be 75 to 80 percent as efficient in nearby rural hospitals as we are in our ASC. In the hospitals, we typically only have one phaco machine, one autoclave, and one OR––but we manage to perform the surgeries and turn around the rooms in about 20 minutes.

With competition for cataract surgery increasing, and with reimbursement dropping, greater efficiency has become imperative. Here are some suggestions on how you might be able to do cataract surgery more efficiently.

1
Commit to greater efficiency. It is important to understand that improving efficiency is critical, for two reasons. First, it may be the only way to keep cataract surgery at your facility. Surgeons want and need to be more efficient. Physicians' fees for cataracts are only about a third of what they were 15 years ago. Although new technology and techniques allow many surgeons to do uncomplicated cataract cases in 10 minutes or less, all that speed is for naught if the surgeon must cool his or her heels for 30 minutes between cases while the staff turns the OR over. Rapidly performed turn-arounds are why highly efficient ASCs are competing for cases so successfully.

Second, thanks to the Outpatient PPS, cataract surgery reimbursement has dropped by about 10 percent. In 1998, the average reimbursement to hospitals for cataracts was $1,434. The new outpatient PPS drops the cataract facility fee for hospitals to just under $1,300. If your margin on cataracts was thin already (in 1998, the average reported cost for doing the procedure was $1,738), one way to save is by being more efficient. If your OR time averages $20 a minute, as it does in many facilities, you can save $200 per case just by shaving 10 minutes off the procedure/ room turn-around time.

2
Assign one registered nurse to coordinate the efficiency project. Solicit the help of a surgeon with ASC experience, and ask him or her to train just one nurse, who can then train the rest of the staff. This streamlines the training duties and simplifies the transition process, because everyone only has one point person to deal with.

3
Set up your facility for efficiency. Approach the infection-control department about approving the arrangement of a sterile room for prepping. Set up next to the OR, (it can simply be an unoccupied OR), this room will allow the scrub tech to prep and drape patients there instead of waiting to do it in the OR, or allowing the surgeon to do it. As soon as the surgeon finishes the previous case, the scrub tech can roll the patient into the OR, return to the prep room, and start preparing the next patient.

In addition, instead of using operating tables, plan to have your surgeons do their cases on your rollers. You can use two arm boards and a standard foam headrest underneath a patient's head to extend it about 18 inches past the end of the table. This will allow the surgeon to fit his or her knees underneath and work closely. We typically have three rollers going at a time: one for patients being prepped, one for the OR, and one for transport from pre-op or post-op areas.

4
Use prepackaged supplies rather than reusable ones. Meet with your surgeons to have them agree on as many prepackaged sterile-supply packs as possible, to be used as standard items. Not having to pull instruments from several different places will save the scrub tech time in setting up, and agreeing on some standard packs may allow you to make bigger-volume purchases, resulting in substantial cost savings.

5
Encourage anesthesia pre-screenings. Ask the anesthesia department to begin a practice of calling patients the night before surgery to do pre-screening. This will save time on the day of surgery.

6
Set up a triple-check system. As you are changing your system and pick up the pace, the need to review grows. At least two, and preferably three, people should be responsible for checking the patient's name, the IOL, and the eye that is being operated on. The last person should do his or her check just before surgery begins.

7
Invite the surgeon's surgical coordinator to be present in the post-op area. This way, a member of the surgeon's own staff can be responsible for providing verbal and written instructions.

As always, don't attempt to change many things at once; this could be overwhelming and discouraging. Take deliberate, organized steps, and congratulate your team on every small success. The rearranging and time spent retraining personnel will pay off, with greater efficiency and personal satisfaction. The key to "operating like an ASC" is teamwork and effective communication, with your surgeons as much as your staff.