Patients continue to migrate from the hospital to the Ambulatory Surgery Center (ASC) space for care. This scenario presents surgery centers with significant growth opportunities.
To make the most of the situation, however, ASC leaders must help their teams overcome a myriad of change management and operational challenges that occur daily.
Here, Marvella Thomas, senior consultant in ASC clinical operations at Cardinal Health, answers seven questions on driving ASC growth while supporting patients and clinicians.
Question: How have you seen the ongoing pandemic impact how ASCs operate on a daily basis?
Marvella Thomas: The pandemic accelerated the growth we had been anticipating in the ambulatory market. It was almost overnight as the country started to recover from the initial impact and shutdown of all operations. Ambulatory centers had to quickly adapt to the changes required for the increased volume. COVID-19 affected many areas in the facility and leaders had to consider.
- Increase in surgeons, patients, and procedures.
- Impact of supplies and inventory levels.
- Staffing challenges and stress on staff
- Patient throughput issues
- Collateral resources; SPD, Business Office
Q: Which of these considerations presented the most challenges to facilities?
MT: The most significant impact from the pandemic has been the surge in procedures migrating to the ambulatory setting. Hospitals were eliminating or reducing elective procedures from their OR to allow clinicians to focus on the increasing number and severity of COVID-19 patients. In addition, surgeons and patients wanted to reduce the exposure risk in the acute facilities. Surgeons that had always practiced in the acute space, now wanted to move to the ambulatory space. For example, one facility went from two plastic surgeons on staff to 13. This moved more patients to the safer and accessible ambulatory area. The sudden increase in volume created some unique challenges for these surgery centers.
Q: In what ways can a facility manage the increased need for more supplies that comes with a higher patient volume?
MT: Higher inventory levels for supplies were needed to support the increase in activity. Facilities not only needed more of their current supplies, but they also needed procedure and physician specific supplies for new surgeons and new procedures. This challenge was magnified by an already strained global supply chain. And if or when supplies arrive, where can they store the additional volume of supplies? Storage and space are almost always issues in most ASCs. Creativity and planning can help reduce the strain of the additional supplies and equipment needed to handle the increased volume. Keep these considerations in mind:
- Get rid of anything you don't need, excess, obsolete and expired items. This will create some additional space.
- Make sure you have the correct inventory levels for the items you do need.
- Work with vendors on delivery options. It may be possible to increase your days of delivery to allow for placement of smaller orders.
- Some facilities are placing portable storage units outside the building for equipment and bulk supplies that don't need a controlled environment.
- Partner with other local facilities. They are struggling too. You may be able to share or access supplies from them.
- Be patient with your materials manager. They are doing all they can to access supplies the clinicians need.
We talked about additional supplies but don't forget instrumentation. Are there enough instrument sets available for the increased volume and are there resources in Sterile Processing to handle the growth? There are downstream effects everywhere.
Q: You mentioned increased stress on the ASC staff, what are some things facilities can do promote staff wellness?
MT: The impact on staffing levels has also been challenging. ASCs don't operate on a 24/7 schedule and are having issues juggling hours of operation with available staff. Facilities are operating later in the day and running full schedules on Saturday. Shortages have existed for some time, but now are complicated with COVID-19 fatigue and fear, vaccine mandates, and generalized stress facing clinical resources. Some facilities were forced to close temporarily and furloughed staff. Those clinicians may have moved to other jobs. We need to offer more flexible hours to help staff meet changing needs for childcare and school schedules. Encourage break times and provide an area for those breaks. Consider providing lunch, if possible, even if it's one day a week.
Q: How has patient throughput been affected and what can centers do to deal with the challenges?
MT: Patient throughput has become problematic. More patients are utilizing the same number of procedure rooms and Post-Anesthesia Care Unit (PACU) beds. This can strain those resources. Some facilities have had to hold patients in the OR until beds are freed up in the recovery area. This bogs down your whole schedule. Manage the daily schedule to maximize available resources. I see facilities using PACU bays for additional storage of supplies or equipment. Free those areas up to increase available PACU space.
Turnover times are more critical now than ever. We have to do more cases in the same number of rooms with close to the same hours of operation. We can't always control turnover times, but we can impact our case set up times. Bundle as many supplies as you can to reduce the number of items that need to be accessed and opened for procedures. Stage case carts as close to the ORs as possible.
Q: Are there other areas that may be overlooked with the increase in patient volume?
MT: We often forget to assess the impact the volume increase has on your sterile processing team. The increased volume will increase the need for instrumentation. It's important to make sure you have the equipment and resources to process and sterilize the trays needed for the daily schedule.
There is additional stress and activity placed on the business office. They have new physicians to credential. New insurance companies to work with, and an increased workload from the higher volume.
Q: Do you have any tips or advice for those managing the daily obstacles they face in the current ASC industry?
MT: We've got to be flexible — the status quo won't carry us through current challenges. Be open to new processes, new procedures, and new staff. If you can't get supplies, have alternatives ready to go – have a plan B in place. It's also important to make sure your clinical staff knows when and why a product is unavailable due to supply constraints. Communicate that due to supply shortages, you may not get everything you want, but you will get everything you need. Involve the clinical team in picking clinically acceptable substitutes. Overall, keep your clinical team aware of ongoing supply challenges to prevent negative patient outcomes. Everyone needs to be flexible with what they can use and keep open communication.
Even with these challenges, we need to focus on the tremendous opportunities for the ambulatory surgery setting. The health care community now recognizes the importance and capabilities we can offer to patients and the entire system of healthcare.
To optimize operational efficiency in your facility and best adapt to the increased volume, request a no-cost supply chain assessment with Cardinal Health. Our team will uncover process improvements, evaluate supply usage, and find savings opportunities using data and analytics.