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With all of the proposed changes to Medicare regulations for outpatient centers, it might be time to conduct an analysis of your facility’s staffing requirements.
Staffing is one of your biggest expenses. If you need to consider some cost cuts, now is a good time to make sure the number of employees is adequate but not excessive.
Though every facility will have its own needs and considerations, there are some general guidelines to follow, says Vicki B. Sullivan, RN, CNOR, director of surgical services for Quad City Ambulatory Surgery Center in Moline, IL. Quad City is a freestanding, physician-owned center that performs approximately 150 procedures a month. Sullivan’s experience includes developing an ambulatory surgery center (ASC) from the ground up.
"Staffing is one of the most difficult things to develop in a surgical center because surgical volume is not consistent," she says. Sullivan offers these guidelines to developing staff for a new center, or expanding or reducing staff at an existing facility:
1. Determine staffing needs.
First, consider the center’s size by answering these questions:
• How many operating rooms are there?
• Do you have a minor procedure room that is used at the same time as the operating rooms?
• How are these rooms scheduled? "When our facility utilized a second room, I looked at the amount of time I anticipated using that room, and we had to almost double the staff," Sullivan says.
• What is the facility’s physical layout? Sullivan says the physical layout could decrease or increase staff hours. For example, staff in preoperative and recovery areas might be able to assist each other if the two areas are adjacent. "The design of our center enables staff to have visual access to all these areas."
Second, outline the procedures and services your facility provides. For example, an ASC usually needs staff in the areas of surgery scheduling, preoperative assessment and patient education, admission, operating suite, and recovery rooms. Whether these areas are staffed by RNs, LPNs, or other health care workers depends on the facility’s policy.
Last, the staffing requirements depend on the center’s goals and desired outcomes. If a center chooses to be accredited by a governing body, then the staffing levels should be raised to meet those standards. Also the state’s licensing requirements may dictate a staff-to-patient ratio in recovery areas.
2. What kinds of skilled staff are needed?
Sullivan charted the types of staff necessary for her facility by drawing two simple diagrams. One demonstrates the staff needed for a single operating room. This includes a receptionist, a preoperative nurse, four operating room employees, one first stage recovery nurse, and one second stage recovery nurse. The facility may hire a nurse educator and employees to handle non-patient responsibilities.
The second diagram lists the staff for two operating rooms where they could be shared. This staffing might include two preoperative nurses, six operating room employees, and two each of first and second stage recovery nurses. All employees, except the preoperative nurse, could be used to assist and relieve their counterparts in the second operating room.
After completing the diagrams, Sullivan wrote the staffing requirements in terms of full-time equivalents (FTEs). For example, the preoperative RN position in a single operating room is written out as 1 FTE. She added up the total to arrive at a figure of the staff required in the facility.
3. Determine staffing costs.
Once you have the number of FTEs per position, you can easily figure out how much your staffing needs will cost. First, use your actual average hourly wages for each discipline or an estimated hourly wage. Chart these in columns, entering the total hourly cost to the far right column. The bottom of the column will give the total average hourly cost. (See charts, pp. 96-97.)
Sullivan says it’s probably a good idea to use FTEs instead of full time and part time positions when determining the total cost; because full-time employees often change to part time or vice versa, and your ratio probably will not remain stable.
"I don’t think there’s any rule for a ratio of full time to part time. It depends on the qualifications of the people you employ, and what their desires are."
For more information on staffing an outpatient facility, contact:
• Vicki B. Sullivan, RN, CNOR, Director of Surgical Services, Quad City Ambulatory Surgery Center, 520 Valley View Drive, Moline, IL 61265. Telephone: (309) 762-1952. Fax: (309) 762-3642.