Bunny Twiford, RN, president of Twiford Consulting in Warminster, Pa., shares six things GI-driven ASCs should benchmark.
1. Length of the procedure vs. scheduling allotments. Ms. Twiford says ASCs should benchmark the actual length of GI/endoscopy-related procedures, such as EGDs and colonoscopies, and compare those time frames to physicians' scheduled allotments or block scheduling. Benchmarking this will allow GI/endoscopy-driven ASCs to better schedule procedures for improved room utilization and patient throughput or zero in on re-educating specific physicians and staff members on the importance of starting on time.
"A physician might say he can do an EGD in 10 minutes, but when you go back through your ASC's records you find that this physician's average EGD is more in the 15-20 minute range," Ms. Twiford says. "This causes the front desk to deliver the news to some patients that their procedure will be delayed, and this is not what the patient wants to hear upon arriving for a procedure."
2. Reasons for cancellation on the day of the procedure. GI/endoscopy-driven ASCs should also benchmark reasons patients are cancelled on the day of the scheduled procedure. This would allow ASCs to categorize the reasons so that solutions could be found. Ms. Twiford says poor bowel prep is one of the causes of sudden GI procedure cancellations. Non-adherence to "nothing by mouth" or NPO instructions or a patient with cold or flu symptoms might be other reasons for a cancellation.
"For example, ASCs don't want to find out at 7 a.m. that the patient stopped their bowel prep," Ms. Twiford says. "Let's say my GI/endoscopy-driven ASC had 14 cancellations in November, and I go back to find 10 of those were bowel prep-related. I have to go back and find out what difficulties or challenges around bowel prep caused the cancellations. Maybe patients aren't understanding the bowel prep procedure or they encountered problems with the bowel prep in the evening when the ASC was closed."
3. Method of pre-op assessment. Benchmarking the method of pre-op assessment of patients is another target for GI/endoscopy-driven ASCs. For example, ASCs may want to benchmark how cost- or time-effective it is to conduct pre-op assessments over the phone versus doing it on the day of surgery with the patient.
"This would be more of an external benchmarking exercise. How many ASCs in Indiana do pre-procedural calls versus in-person nursing assessments with patients, and how much time does it really save them?" Ms. Twiford says.
4. Expected capital equipment expenditures for the next year. GI/endoscopy-driven ASCs typically manage their capital equipment and disposable supplies somewhat differently from most other specialties. For capital equipment, such as scopes and stretchers, GI/endoscopy-driven ASCs should diligently benchmark costs tied to such equipment to project expenditures for the next year.
"ASCs, after being open for 4-6 years, may want to benchmark very specific equipment, such as scopes and stretchers. In a GI center, the patient typically goes through the entire ambulatory experience on a stretcher and isn't moving to an OR table as frequently as some other specialties," Ms. Twiford says. "This means stretchers may be wearing out more quickly because patients are using those stretchers more frequently and for longer periods of time. ASCs have to get some kind of idea of how long of a lifespan each piece of equipment has."
5. Marketing due to increased competition. For more mature GI/endoscopy-driven ASCs, another factor to benchmark regularly is local competition — if it's increasing or decreasing — and marketing methods for increased staff and physician retention.
"There appears to be a movement of physicians in and out of some ASCs. Some who might have been with a group for a number of years may decide to open their own GI center," Ms. Twiford says. "Physicians are also retiring and younger physicians are moving around much more frequently than was traditionally done. All these factors have to be considered, so the ASC has to really know where the competition is and how to keep itself marketable in face of that."
6. Educational benefits for the GI staff. Educational benefits for GI staff members are a crucial part of ensuring top-notch competency in their respective roles. Investing in ongoing education also gives staff members a reason to stay loyal to your GI/endoscopy-driven ASC, thereby retaining a higher percentage of staff members over time. As such, GI/endoscopy-driven ASCs should externally benchmark educational benefits it gives staff members.
"GI centers will want to look at other center to see what would be a great set of educational benefits for its staff. Perhaps it's that every year the center sets aside x amount of money for every single member's continuing education or send two individuals to the ASGE conference," Ms. Twiford says.
Bunny Twiford, RN, is a member of SGNA, AORN and APIC. She is currently President of the Bux-Mont Chapter 3912 of AORN in Pennsylvania. Learn more about Twiford Consulting at www.twifordconsulting.com or you can contact Ms. Twiford at twifordconsulting@gmail.com.
1. Length of the procedure vs. scheduling allotments. Ms. Twiford says ASCs should benchmark the actual length of GI/endoscopy-related procedures, such as EGDs and colonoscopies, and compare those time frames to physicians' scheduled allotments or block scheduling. Benchmarking this will allow GI/endoscopy-driven ASCs to better schedule procedures for improved room utilization and patient throughput or zero in on re-educating specific physicians and staff members on the importance of starting on time.
"A physician might say he can do an EGD in 10 minutes, but when you go back through your ASC's records you find that this physician's average EGD is more in the 15-20 minute range," Ms. Twiford says. "This causes the front desk to deliver the news to some patients that their procedure will be delayed, and this is not what the patient wants to hear upon arriving for a procedure."
2. Reasons for cancellation on the day of the procedure. GI/endoscopy-driven ASCs should also benchmark reasons patients are cancelled on the day of the scheduled procedure. This would allow ASCs to categorize the reasons so that solutions could be found. Ms. Twiford says poor bowel prep is one of the causes of sudden GI procedure cancellations. Non-adherence to "nothing by mouth" or NPO instructions or a patient with cold or flu symptoms might be other reasons for a cancellation.
"For example, ASCs don't want to find out at 7 a.m. that the patient stopped their bowel prep," Ms. Twiford says. "Let's say my GI/endoscopy-driven ASC had 14 cancellations in November, and I go back to find 10 of those were bowel prep-related. I have to go back and find out what difficulties or challenges around bowel prep caused the cancellations. Maybe patients aren't understanding the bowel prep procedure or they encountered problems with the bowel prep in the evening when the ASC was closed."
3. Method of pre-op assessment. Benchmarking the method of pre-op assessment of patients is another target for GI/endoscopy-driven ASCs. For example, ASCs may want to benchmark how cost- or time-effective it is to conduct pre-op assessments over the phone versus doing it on the day of surgery with the patient.
"This would be more of an external benchmarking exercise. How many ASCs in Indiana do pre-procedural calls versus in-person nursing assessments with patients, and how much time does it really save them?" Ms. Twiford says.
4. Expected capital equipment expenditures for the next year. GI/endoscopy-driven ASCs typically manage their capital equipment and disposable supplies somewhat differently from most other specialties. For capital equipment, such as scopes and stretchers, GI/endoscopy-driven ASCs should diligently benchmark costs tied to such equipment to project expenditures for the next year.
"ASCs, after being open for 4-6 years, may want to benchmark very specific equipment, such as scopes and stretchers. In a GI center, the patient typically goes through the entire ambulatory experience on a stretcher and isn't moving to an OR table as frequently as some other specialties," Ms. Twiford says. "This means stretchers may be wearing out more quickly because patients are using those stretchers more frequently and for longer periods of time. ASCs have to get some kind of idea of how long of a lifespan each piece of equipment has."
5. Marketing due to increased competition. For more mature GI/endoscopy-driven ASCs, another factor to benchmark regularly is local competition — if it's increasing or decreasing — and marketing methods for increased staff and physician retention.
"There appears to be a movement of physicians in and out of some ASCs. Some who might have been with a group for a number of years may decide to open their own GI center," Ms. Twiford says. "Physicians are also retiring and younger physicians are moving around much more frequently than was traditionally done. All these factors have to be considered, so the ASC has to really know where the competition is and how to keep itself marketable in face of that."
6. Educational benefits for the GI staff. Educational benefits for GI staff members are a crucial part of ensuring top-notch competency in their respective roles. Investing in ongoing education also gives staff members a reason to stay loyal to your GI/endoscopy-driven ASC, thereby retaining a higher percentage of staff members over time. As such, GI/endoscopy-driven ASCs should externally benchmark educational benefits it gives staff members.
"GI centers will want to look at other center to see what would be a great set of educational benefits for its staff. Perhaps it's that every year the center sets aside x amount of money for every single member's continuing education or send two individuals to the ASGE conference," Ms. Twiford says.
Bunny Twiford, RN, is a member of SGNA, AORN and APIC. She is currently President of the Bux-Mont Chapter 3912 of AORN in Pennsylvania. Learn more about Twiford Consulting at www.twifordconsulting.com or you can contact Ms. Twiford at twifordconsulting@gmail.com.