Tips and tricks for the SDS trade

By Stephen W. Earnhart, MS CEO Earnhart & Associates Houston, TX

Few ideas I come up with or speak about are original. Sometimes I think they are, but I might have heard them from a doc, nurse, Seinfeld show, or a conference.

I want to share some of my favorite “tips and tricks” this month and, if you like them, I can do them again. (See the last paragraph of this column!)

Disrobing cataract patients.

I’ve spoken about and written about this for years, so it could be my idea. Not sure. There is absolutely no reason why our patients having cataract procedures under local or local sedation need to disrobe! It is time-consuming and a stress on our patients. Make sure you advise them in the preop call to wear loose fitting clothes so you can get the chest leads on, and then leave them be. Another thing: Why do you start an IV on these patients? It’s a 15-minute case. (I hope!) Save the time, the money, and these poor patients’ veins. By the way, the greatest patient complaint from cataract patients is the needlestick for the IV. Let it go.

Preop testing.

How many of you require routine preop testing for your patients? None, I hope. There is never a situation when your facility should require routine preanesthesia testing. It is a building! Anesthesia might require it. The surgeons might want to get into it, but your building? No way. Find out who actually wanted the tests in the first place (probably anesthesia), and find something to eliminate. Chances are no one has looked at them in forever anyway. (Editor’s note: For more information on eliminating preop testing, and other cost-saving moves, see the special February 2013 issue of Same-Day Surgery on your peers’ best ideas for saving money.)

• 45-minute patient arrival time.

It seems as if half of my friends and family are having surgery lately, and I just hate sitting there with them for two hours before their surgery trying to think of something to say while peeking at my emails on my phone. Knock it off! No need for this early arrival anymore. You might not want to reduce that time to 45 minutes right away, but work on it. It could be you having to sit there some day. (For more on this topic, see my column “13 steps to convert to 45-minute arrivals,” SDS, October 2010, p. 115.)

Patient privacy.

Forget doing this just because of privacy regulations. Just have your front desk staff members learn to ID patients by where they are sitting in the lobby. Direct the nurse to them from where they are sitting instead of calling out their name as if their table is ready at the local barbecue restaurant. It is starting to irk me that the people at the front desk can’t remember that Mrs. Brown in seating in the first row at the end of the bench, or that the pierced and tatted blonde with ear plugs is in the back row. We can do better than this.

Texting on the job.

We can’t do it at the movies (although some jerks do), so why can we do it during Sally’s hysterectomy? Really? I can’t tell you how many times I have had someone text me “... gotta run, taking the patient off the table.” Place phones in a box in the room, and make it a requirement that staff members leave them there until after the case. (Editor’s note: For more on this topic, see “Distracted doctoring’ recognized as hazard,” SDS, April 2012, p. 42.)

Send me home with pay when my room is finished.

If you have full-time staff members who have busted their butts to turn over their rooms and finish their cases early, send them home with pay. Why not? They increased your efficiency, they make the surgeons happy by getting them out early, the patients don’t know or care, so everyone wins! Don’t make them hang around trying to look busy when they have done their jobs. Set them free! I do not know of any nurse who should be paid by the hour. It is the job and the responsibility that matters. Rise up!


I refuse to spell out what EMR stands for. If you don’t know, then just skip this tip. People, it is time! Join the electronic age, and just convert. It is so much better, and it makes all of our lives easier. You can download a movie and watch it on your phone, but you still have a paper chart?


Members of your staff or cleaning crew might be stealing from you. Perhaps you can’t stop it, but you can deter it. Go to your local electronics store, and put in a few fake cameras around the place. They cost about $19.85 each. I mounted one in my car, just in case. It might make them think twice. Don’t do like the manager who told her staff at a meeting that the cameras were fake. (For more on this topic, see “Video cameras shine as your best detective,” SDS, April 2011, p. 39.)

I need to hear from every one of you reading this if you want more of these. Send me an email even if it is only “yes!” If you have a phone that can email, just don’t do it from the OR. [Earnhart & Associates is a consulting firm in Houston, TX, specializing in all aspects of outpatient surgery development and management. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: Web:]