Safety

mproved staff efficiency leads to positive survey feedback

Ambulatory Safety Monitor, May 26, 2005

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The Surgery and Laser Center in Seneca, PA, has used several nonverbal communication strategies to improve its processes over the past few years. And those efforts didn't go unnoticed when an Accreditation Association for Ambulatory Healthcare (AAAHC) surveyor visited the facility in December 2004.

"Overall, she had very positive things to say about our organization," says Rhonda Schmader, RN, center director.

Better communication means increased efficiency

One of the physicians at the center is also a pilot and brought with him techniques he learned in the aviation business, including using checklists. These checklists include vital steps that will benefit even veteran healthcare providers.

"Whether it's admissions, preop, or the operating room (OR), we go through the same routine each time," Schmader says. "If someone misses a step, it slows the process for everyone and may lead to preventable errors."

Although checklists among departments are easy fixes to achieve consistent quality, the center also began using nonverbal techniques to make sure communication flows among all healthcare providers in all departments.

For example, they put a twist on the time-out model many organizations use before surgery. In a traditional time-out, the surgical team pauses before the procedure to make sure it is about to work on the correct patient, site, and side.

Surgery and Laser Center takes a time-out in the preop area by requiring the anesthesia personnel to assess the patient before he or she enters the OR. Anesthesia then place a black clip on the file signifying that a complete assessment has been made and that the doctors can proceed.

Another nonverbal technique the center uses to foster efficiency is to turn charts in the rack in the post-anesthesia care unit (PACU) on their sides to indicate patients ready for discharge.

Discover opportunities for improvement

Once a year, Schmader and her team collect data about the center's processes and compare them against the previous year's statistics to determine where it could improve and where it achieved improvement goals in the past.

By collecting data annually, the team can benchmark against itself more accurately every year. For example, these studies focus on how much time a patient spends

  • in the lobby

  • in preop

  • in the OR

  • from PACU to discharge

  • in recovery time

  • in the surgery center (overall length of stay)

    Schmader's team also reviews turnover time between each case. This information informs administration whether it needs more staff or whether it must redirect its existing resources, Schmader says.

    Educate your patients

    Involve your patients in communication about their care to ensure safe procedures and quicker turnaround.Patient education should begin before arrival to the facility. Perform a preop phone call with the patient and a nursing assessment. During these calls, review the procedures with patients, telling them what to expect, Schmader says.

    When patients arrive for the procedure, Surgery and Laser Center educates patients about the

  • patient bill of rights

  • patient privacy notice

  • discharge instructions

    A nurse then reviews this material in preop and gives patients folders with information about their procedures and what to expect postoperatively, including specific diagnosis instructions.

    "If you begin all this education prior to patients receiving anesthesia, they will remember it better," Schmader says.



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