Department of Surgery

Consolidation of SurgiCenter

into the Main OR

June 2013

Contents

• Proposed Gantt Chart for transition
• Current and Projected Patient Volume
• Current and Projected Staffing Needs

​

Week One

• Extrapolate last 3 months Short Stay Census data to determine total

number cases

2. Review SC documentation and forms; Standardize to one outpatient

form/set

3. Periop Director to meet with stakeholders to discuss consolidation of

services

4. Review current staffing matrices for each unit-Surgicenter and Hospital

5. Forecast staffing matrices of combined services

6. Review total number pediatric cases Surgicenter last 3 months

7. Walk through SC/ Main OR

8. Walk through SC/ Main OR with key staff June 21, 2013

9. Discussion with Director of Admitting regarding T. Perez Or registration

process

Week Two

1. Walk through and evaluate Cysto #1

2. Create Inventory list, and relocate OR supplies from OR #16

3. Determine office space for surgery center, and storage for supplies

4. Surgery Center equipment inventory

5. Surgery Center supplies and paper work inventory

6. Discuss with Peds. Director surgical Peds cases

​

Week Three

1. Cross train staff and orient for Main OR as schedule permits

T. Perez to registration

Richard to central processing

Two SC RNs to PACU

Two SC RNs to Short Stay

Short Stay RN's to Opth. Cases

2. Surgery center charge nurse cross train to Main OR

​

Week Four

1. Continue cross training

2. Move minor supplies and equipment from SC

3. Prepare OR suites and offices

4. Communication to stakeholders regarding admitting

5. Contact IT regarding computers

6. Contact communication services regarding phones

​

Week Five

1. Coordinate with facilities and vendors regarding equipment

2. Begin major equipment move

3. Complete cross training

​

Week Six

1. Finish moving major equipment

2. Final walk through of OR suites for compliance

3. Coordinate medication move with pharmacy

​

Week Seven

1. Finalization of week one through six

​

Week Eight

Ambulatory Surgery Unit �Short Stay

• Short Stay provides care for a variety of patients:
• Blood and other infusions
• Hearth Catheterization
• D&C
• Medical and Other Procedures
• PAT
• AM Surgical Admits
• Post Surgical

Short Stay Volume by patient type

Projected Patient Increase for Short Stay

​

• Short Stay can expect an increase in PAT and surgical patients
• Based on average monthly census for SurgiCenter of 85 patients
• Average monthly pediatric population of 20 would be considered in PAT but not post surgical for Short Stay as they would go to the Pediatric unit

Projected Increase for Short Stay from Former SurgiCenter patients

Projected Increase for Short Stay from Former SurgiCenter patients

• Assumes same percentage of patients that present for PAT will continue to present – does include pediatric PAT
• PAT volume will increase to 123/mo – an addition 2.7 patients a day (assumes a 22 day month)
• Surgical cases will increase to 151/mo – an average of 2.9 patients a day (excludes pediatrics)

Current Short Stay Staff

• Current Staffing Levels in Short Stay are:

- RN 2 – 3 depending on anticipated

patient census

- CNA

- Administrative Assistant

Projected Short Stay Staffing

• In order to accommodate the increase in patient volume of 5.6 patients per day, it is anticipated that staffing levels will need to be:

- RN 5 or 6

- CNA

- Administrative Assistant

- Admission Clerk

Holding Room

• All patients present to the Holding Room for their final preparation, interview by anesthesia, consent check and marking by the surgeon
• Exception –Trauma patients and intubated ICU patients do not stop in the holding room

Current Holding Room Staffing

• One RN

​

Assisted by OR nurses and PACU nurses as necessary

Projected Holding Room Staffing

• At this time, there are no recommendations for adjusting the staffing level in the Holding Room

Current OR RN Staffing

• Current Staffing levels are guided by PeriOp Policy A-02
• Current Day Shift RN Staffing is approx 5

Projected OR RN Staffing

• Anticipated increase in surgical cases of 3.8 per weekday (including pediatrics)
• The types of surgery, length of cases and availability of anesthesiology will determine how many additional rooms will need to be opened
• In order to accommodate the increase in patient volume it is anticipated that staffing levels will need to be 6 RNs

​

Current Surgical Tech Staff

• Current Staffing levels are guided by PeriOp Policy A-02
• Current Day Shift Surgical Tech Staffing is approx 4

Projected Surgical Tech Staffing

• Anticipated increase in surgical cases of 3.8 per weekday (including pediatrics)
• The types of surgery, length of cases and availability of anesthesiology will determine how many addition rooms will need to be opened
• In order to accommodate the increase in patient volume it is anticipated that staffing levels will need to be 5 Surgical Techs

​

PACU Volume

PACU Current Staff

• The PACU is currently staffed by 3 RNs on the day shift

Projected PACU Staffing

• Anticipated increase in surgical cases of 3.8 per weekday (including pediatrics)
• All surgical patients are 1:1 ratio until stable
• All Pediatric patients are 1:1 ratio for the duration of their time in recovery
• In order to accommodate the increase in patient volume it is anticipated that staffing levels will need to be 5 RNs

Ancillary Staff

• The Department of Surgery uses OR attendants whose job duties include:

- Cleaning rooms between procedures �- Assisting with transport of patients to and � from the department

- Retrieving Blood

​

Realignment of Staff

• Gliz would be utilized to input charges, maintain current preference cards, daily statistics, assist with acquisition of supplies, relieve director/charge nurse prn
• The Surgical Tech fro Surgi Center should be absorbed into the main OR to accommodate the increase in census
• The 2 OR RNs from SurgiCenter should be absorbed into the Main OR to accommodate the increase in cases and to maintain continuity for physicians from the SurgiCenter
• The 4 PACU RNs from SurgiCenter:

Two to Short Stay

Two to PACU

• The Administrative Assistant from SurgiCenter to become the Admission Clerk
• The SPD person from SurgiCenter to work a staggered shift to process the additional instruments

Future

• At this time, there is no way to predict what the eventual patient volume will be. In order to ensure a smooth transition for our patients and the physicians, it is requested that the proposed staffing recommendations be implemented. After a reasonable transition period, staffing levels may have to be re-evaluated and adjusted. The Department of Surgery will continue to flex staff as dictated by patient census and acuity.