to become independent. This will increase your SH/C. Benchmarking: You cannot bench-

mark two different centers with SH/C. Even same-specialty ASCs could have different SH/C because of all the factors listed above.

A New Method

The total clinical care time or direct patient care time (DPCT) that a facility needs changes constantly from hour to hour and day to day. What you really need to measure is the DPCT and any excess hours (EH) above this. DPCT is the time needed to safely and efficiently take care of patients within acceptable guidelines, such as ASPAN’s nurse-to-patient ratios. This time is what you absolutely need to take care of your patients for the day. Anything below that is possibly unsafe and will provide poor service to your patients and physicians.

Staff hours per case fits well into financial modeling, however, medicine does not really work like financial modeling.”

— Arne Brock-Utne, MD Issio Solutions Inc.

EH is time needed for taking care

of non-direct care time tasks, such as restocking carts, checking code carts,

preop phone calls, etc. You need some EH to take care of these tasks, but you do not want too much. Too much EH will result in overstaffing and over- spending on labor. You will want to set a percentage of EH that you are com- fortable with for your facility in the operating room (OR) and preop/post anesthesia care unit (PACU). Since it is a percentage, the amount of EH allow- able will decrease with the number of cases you have. The percentage of EH needed depends on the type of facility and how overstaffed it is at the current time. You would want to decrease your EH gradually over time; all at once could cause whiplash for your staff by exposing all the inefficiencies that have crept in over time. How do you measure DPCT? In the ORs, you need to take into account set-up and break-down times, number of staff needed for each OR (this can change depending on the type of anes- thesia and case) and a few other factors. In preop/PACU, DPCT depends on

who the patients are and what anes- thetic they are scheduled to have. These factors change the


patient ratios and the ratio changes hour by hour.

When you measure DPCT and EH, you can track how much time is needed to keep patients safe and can set how much EH are needed to keep the facil- ity safe and prepared. You can easily benchmark facilities against each other regardless of their specialty. Remember, your clinical care time changes all the time. A case is not a case is not a case. These are people and patients, and each one has different nursing and care requirements. In this age of pay for performance and online reviews, you really cannot afford to rely on SH/C as a labor metric.

Arne Brock-Utne, MD, is the president of Issio Solutions Inc. in Concord, California. Write him at

30 ASC FOCUS MAY 2018 |

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