Personalized Care Achieving an effective nurse-to-patient ratio BY ROBERT KURTZ


iedmont Surgery Center at the Piedmont Orthopaedic Complex in Macon, Georgia, strives to maintain a one nurse to one patient ratio, says Jessi Hammond, RN, the ASC’s direc- tor. The reasons are twofold. “Patient safety is the top reason,” Hammond says. “A 1:1 ratio really allows the nurse to pay close attention to the patient. While this is important throughout a visit, that time when the patient is coming out of anesthesia is a particularly critical period in the patient’s recovery.”

The second reason is customer ser- vice, she says. “People have a lot of choices nowadays of where they can go for care. We differentiate ourselves here because we are a smaller facility providing a high-touch patient experi- ence that is supported by the 1:1 ratio.” Efforts to deliver such an experi-

ence have not gone unnoticed, Ham- mond says. “In our satisfaction sur- veys,

patients consistently comment

about the high patient touch and the caring that goes along with it. We hear frequently from patients that they plan to tell friends and family about their experience. That leads to referrals to our practice and ultimately more patients for the surgery center.” For ASCs to determine an appropri- ate nurse-to-patient ratio, Anne Dean, RN, founder of The ADA Group, an ASC consulting firm based in DeLand, Florida, says they need to make staff- ing decisions that allow them to pro- vide safe care while staying within staffing guidelines. “This can include guidelines from the American Society of PeriAnesthesia Nurses and Asso- ciation of periOperative Registered Nurses, and state regulations.” Under those guidelines, a 1:1 ratio is not necessary in most areas of the ASC, but Dean advises her ASC cli-


Even if your processes are so refined that caring for patients is like running a conveyor belt, every patient should feel like they matter most.”

—Anne Dean, RN, The ADA Group

ents to maintain it during the period in recovery when a patient first comes out of the operating room (OR) since patients are often disoriented when they wake up from anesthesia. “This does not mean you need to have one nurse for every patient in the recov- ery room, but rather it is about how you stagger the patients coming into recov- ery,” Dean says. “Your nurses should not be taking care of two patients who are both coming out of the OR at the same time because these patients need the same ‘high quantity’ of care. After that initial period of time in recovery passes, a nurse can leave one patient’s bedside to check on another patient. It is impor- tant for nurses to have clear lines of sight from one patient bed to another, and for patients to have an emergency button they can press, if necessary.” In the event that Piedmont Surgery Center gets busier, nursing staff are cross-trained so they can provide help throughout the facility, Hammond says.

“If the discharge nurse does not have

any patients, that nurse can flow into the post-anesthesia care unit (PACU) and take over the patient that is getting ready to go home so the PACU nurse can focus on the patient that is coming out of surgery,” she says. “I can also step in and help.” Hammond says, “When costs go up and reimbursement goes down, it can be difficult to maintain the level of staffing you need because sometimes that may require extra staff, which is an extra cost. But what you are getting out of having extra people is extremely valuable and well worth any increase in cost.”

Dean says ASCs should stay focused on making staffing decisions based on the ability to provide individ- ualized care. “Even if your processes are so refined that caring for patients is like running a conveyor belt, every patient should feel like they matter most.”

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