able when they happen. For example, say you find that patients associated with a certain physician, anesthesia pro- vider or staff member routinely remain in your ASC more or less time than other patients. With data in hand, you can sit down with the individual involved, dis- cuss the process he or she follows and make any changes needed to ensure that patients are not only being cared for appropriately but also remaining in the ASC for an optimal amount of time. As an example, if most patients in

your ASC remain in phase two recovery for 40 minutes after a tonsillectomy but all of a given physician’s patients are leaving after 20 minutes, you can assess whether patients are being released too early or whether this team member has a better process that should be followed throughout your facility. Containing costs: As ASCs see

expenses rising and reimbursement tightening, there is little room for unnec- essary spend. Informatics can help catch small problems before they dramatically impact your ASC’s bottom line. For example, with historical data,

you can perform accurate case cost- ing and be able, nearly in real time, to compare the items used during one case to a similar case. You might iden- tify the use of supplies or drugs by a certain physician, anesthesia provider or nurse that might be more expensive than those used during other cases. With the data, you can sit down with

this individual and discuss whether the use of these supplies or drugs is critical to a positive patient outcome or if the options used during the other cases can meet the same needs at a reduced cost. Such a change in practice can result in an immediate savings that does not affect the quality of care provided.

What You Need An ASC will not be able to take full advantage of the promise of clinical informatics without the technology to drive improvements. When researching different types of ASC systems, such

It will not be long until clinical informatics are an essential, required component of operating a successful, compliant surgery center.”

— Daren Smith, RN AmkaiSolutions and Surgical Information Systems

as practice management and electronic medical record systems, it is worth- while to discuss the capabilities of these systems with their vendors and learn whether the technology can provide the types of solutions described earlier. Also, speak with current users of the systems to learn how they are using the technology to bring about changes. Once you have selected and imple-

mented your systems, you will need staff who can use them effectively. Clinical informatics has become so critical to the success of acute care hospitals and other organizations that many facilities now employ clinical informaticists. While this may be fea- sible for some large ASCs, many sur- gery centers will not have the budget to add a full-time employee for this role. ASCs can look at their existing staff and identify team members with

strong technology skills to become the organization’s experts in using the sys- tems and extracting valuable data from them. Through training provided by the systems’ vendors, time allocated for working in the systems and ongo- ing use of the technology, these team members can fill the need. Consider forming a quality commit- tee that is tasked with identifying areas of operations to focus on and request- ing reports from the staff members who work in those areas. When the commit- tee receives the reports, it can then ana- lyze the data and present its findings to other committees composed of physi- cians/governing board members who can make decisions for the clinical and financial health of the ASC.

Getting Started With the technology purchased and staff and processes in place to use it, ASCs might benefit by starting with a simple performance improvement project that does not require extensive statistics or analysis. For example, an ASC could begin by examining room turnover or recovery time. As your ASC becomes comfort-

able with using data and improves its clinical informatics-related processes, gradually work toward tackling more complex areas, such as PONV, pain levels and use of certain drugs and related patient reactions. You might also find that as you examine one area, it will bring up other issues or trends worth examining further. By investing in the right technol-

ogy and developing processes for using systems to their full capacity, your ASC will be positioned to capture the benefits of having a clinical infor- matics approach to technology and can bring about improvements that will touch all aspects of your operations.

Daren Smith, RN, is a clinical solution specialist at AmkaiSolutions and Surgical Information Systems in Armonk, New York. Write him at


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