OR Manager - February 2020 - 30

AMBULATORY
SURGERY CENTERS
FCOTS increase through smarter scheduling
and surgeon accountability
S
tarting the first cases of the day
on time is key for maintaining
the OR schedule. A delay in first
case on-time starts (FCOTS) can lead
to less OR utilization, greater facility
costs, and dissatisfaction among physicians,
OR staff, and patients. It's a
problem in many surgical suites, but
when OR nurse leaders make FCOTS a
priority, they can usually achieve some
improvements.
Diane
Fecteau,
MSA, RN,
CASC, NE-BC
Analyzing the causes for
delays and holding physicians
accountable are
key ingredients for success,
as demonstrated
in a performance improvement
initiative at
Maine Medical Center
Scarborough Surgery
Center
(SSC)
in Scarborough,
Maine. " Patients
expect to have a procedure
started in a reasonable time after their
arrival, " executive director Diane Fecteau,
MSA, RN, CASC, NE-BC, told OR
Manager. " Delayed cases cause patient
and family anxiety and further
delay cases the rest of the day. "
In October 2018, FCOTS at SSC,
a 10-room ambulatory surgery center,
averaged only 50.2%. An Operational
Excellence performance improvement
project was developed to increase the
percentage of FCOTS to 70% or greater.
Causes of first-case delays
" We had very dismal first case on-time
starts for a long time, " says Fecteau.
" We had looked at it as a group and
kept coming up with the surgeon's late
arrival as the main cause, but there was
only so much we could do at that point
to address the surgeon problem. " About
8 months later, however, based on input
from the surgeons, surgical services
30
OR Manager | February 2020
leadership decided to look at OR efficiencies
and chose FCOTS as the place
to begin. " That really gave us the leverage
to address the issue from a surgical
services perspective, " she says.
A multidisciplinary workgroup was
formed, and they began collecting case
delay data.
A root cause analysis of the causes
for late first case starts found that 66%
of the late starts were tied to:
* surgeon late arrival (42%)
* patient late arrival (16%)
* medication issues (8%).
" These findings gave us the traction
to notify all of the surgeons that this
was a priority and that we would be
tracking their first case on-time starts, "
says Fecteau.
Addressing causes of delays
Actions were taken to address the issues
causing the delays, including:
* one-on-one conversations with late
surgeons
* adjusting patient arrival times for
specific patient populations
* calling first case patients the day
before surgery to remind them of arrival
time
* staffing an onsite pharmacist.
" We notified all of the surgeons that
first case on-time starts were a priority
and that we would be tracking and
talking with surgeons who were late, "
says Fecteau. " We also started calling
the first case of the day patients the
day before surgery to remind them of
their arrival time, and posted reminders
to surgeons on communication boards
above the scrub sinks, " she says.
" They have 3 minutes to scrub their
hands and do nothing else but read the
notices we post. "
Another change was to adjust patient
arrival times. There had been a
big drive to not have patients come
to the surgery center any sooner than
they had to, and a blanket arrival time
of 1 hour before surgery had been instituted.
This made it almost impossible
for patients who had to have blocks
infused to be ready on time.
Fecteau says they began to identify
the patients who would need more
time, such as children, elderly patients,
eye patients who need a lot of drops
preoperatively, and those having regional
blocks. They adjusted those patients
to arrive an hour and a half before
their surgery start time.
There had also been a problem with
antibiotic allergies in some patients,
and they took advantage of another
program to get an onsite pharmacist.
" This helped us because before
we were calling a pharmacist on the
phone to talk to the patients, screen
for antibiotic resistance, and determine
if the patient had a true allergy, "
she says. " Having a pharmacist onsite
has made this much more efficient. "
Monthly calendar
Fecteau says they began to see some
improvement in FCOTS, although challenges
with patient arrival remained.
" Some people are just late, and there
is only so much you can do, " she says.
" We tried to do the best we could in
areas we had control over. "
Surgeons continued to be a problem,
and the workgroup decided to start
posting surgeons' names when they
were late on a big monthly calendar.
Every day surgeons were late, their
names were posted on the calendar
(photo, p 31).
If surgeons were late a second time,
their names were posted in bold, and if
they were late a third time, their names
were in caps, and for a fourth time, it
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OR Manager - February 2020

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