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ASCs Face Post-Lockdown Staffing Challenges

With overloaded schedules, surgery centers find creative ways to prevent staff burnout

BY SAHELY MUKERJI | AUGUST 2020

As ASCs settle in after being back from the COVID-19 lockdown, they are reporting various personnel concerns.

The Surgicenter of Kansas City (SCKC) in Kansas City, Missouri, is seeing a higher case volume, says Janie Kinsey, RN, CASC, ASCA Board member and administrator of the ASC. “Physicians are back and not taking vacation time, which is unusual for summer,” she says. “I have a few doctors who take a week off every month, but they are not taking any time off now. The staff, however, is taking vacation because it is summer and that poses staffing challenges. We are doing more surgery from the backlog but with fewer staff.”

The surgery center had a hiring freeze during the six-week lockdown in spring but has resumed recruiting. “In June, after we came back, our budget for volume was 359 cases but we did 492,” Kinsey says. “Most of it is because every doctor worked every single block. Like most ASCs, we keep staffing and expenses lean. Recruiting the right additions to the team takes time and patience. We very much appreciate our awesome team stepping up to take care of our patients during these challenging times.”

With seven sister ASCs in the Kansas City metro area, SCKC has been able to share staff among the centers. “We also use our PRN staff and utilize agency nurses when we can,” Kinsey says. “We are filling five to six operating rooms all day long, rather than starting with five to six rooms and dwindling down to one to two by the end of the day. We are utilizing staff and very efficiently.”

Given that it treats low-risk patients—95 percent orthopedic cases—SCKC does not do COVID-19 testing, Kinsey says. “We have been very fortunate so far and have stayed healthy.”

St. Joseph Center for Outpatient Surgery in St. Joseph, Missouri, serves a small community and partners with a hospital. “For two months—April and May—we had half case volume,” says Lindsey Kroenke, administrator of the ASC. “We cut out our PRN staff during this time. We were fortunate in not having a majority hospital owner and, therefore, were able to qualify for the Paycheck Protection Program (PPP) loan. We were able to keep our full-time staff with the PPP.”

The ASC brought back its PRN staff in mid-June and met its budget in June and July, she says. “Others in the community laid off employees. We had an increased interest and an increase in applicants. We have hired full-time employees and PRN staff in the clinical area.” The center employs 45 people and performs 500–600 cases a month including gastrointestinal (GI), orthopedics, plastic, ENT and podiatry, she says.

Staff is still nervous, Kroenke says. “I have one employee who opted to resign so she could stay home to minimize risk to her family.” She says. “One concern at the very beginning was there was no barrier between the patient and the receptionist. We have fixed this concern by putting up glass panels in the reception area.”

The ASC tests all its patients for COVID-19 at its partner hospital and sees only COVID negative patients. “There are enough tests available because we have worked with our hospital partner,” she says. “Independent labs are turning back test results in seven to 10 days but we get our results back in 36–48 hours.”

Right in the middle of the lockdown, the ASC tried to fill a financial specialist position. “We thought it was a good time to train because our caseload was light, but it was hard to fill because people were on unemployment and probably were trying to get through and wait for the job that they were furloughed from,” Kroenke says. The center has since filled that position and the receptionist position as well. “All our PRN staff, 10–15 of them, came back to us.”

Like the Surgicenter, the Kelsey-Seybold Clinic in Houston, Texas, saw an uptick in patients since being back from the lockdown, says Akshay Tavkar, CASC, administrative director.

“We are going back to normal volume but an ongoing concern of ours is the exposure risk our staff faces in the community,” he says. The ASC is part of a larger accountable care organization and is testing its staff every two weeks. “Testing the entire ASC team, including physicians, has been both reassuring for the staff and our patients. The health and safety of our staff and patients is of the greatest importance, and regular testing for COVID-19 helps improve our chances of reducing exposure risk for everyone but especially our patients who may be more vulnerable post-surgery or procedure.”

All patients are required to test negative for COVID-19 prior to their procedure in the ASC. In the last three months, the center has had to cancel less than one percent of procedures because a patient tested positive, Tavkar says. “The same percent also is true for physicians canceling because of exposure. If employees are required to self-quarantine, the rest of the team steps up to take on additional cases,” he says.

Texas was locked down March 17–April 30. “During the lockdown, we did only urgent cases and our volume was significantly reduced,” he says. “We were able to send some of our staff to other areas, such as our clinic’s COVID Response team, cancer services or other parts of the organization where they could assist with clinical or administrative duties. We are proud that we never had to consider furloughing anyone during this time.”

Kelsey-Seybold Clinic is the largest non-hospital ASC in Texas, with more than 100 employees, more than 50 different surgeons and proceduralists and nine different specialties, including ophthalmology, ENT, podiatry, general surgery, urology, orthopedics, GI, pain management, plastic surgery and obstetrics/gynecology, he says.

The center has had a few job openings since coming back from lockdown. “We are seeing people from the hospital apply,” he says. “We have hired five nurses in the past two months, all from local hospitals.”

Opening after the lockdown, in May, the ASC was a little conservative on purpose. “We brought back 25 percent volume at first, then 50 percent and then 75 percent by the end of May,” Tavkar says. “As we got to June, we were close to pre-COVID numbers. We are at 90 percent right now and we prefer it that way, helping us to strategically prepare for possible exposure. If a staff member calls out because of a known exposure, we would be short-staffed at 100 percent volume. We want to be safe and not overwork our staff.”

Given the volatile nature of the pandemic, staffing could end up being a challenge day to day, Tavkar says, which is why not going up to 100 percent volume has been the right move for Kelsey-Seybold.

“We want to be mindful of keeping our employees and patients healthy and safe, which is why we are good with 90 percent volume now,” he says. “Our employees are comfortable and reassured coming to work every day. We have implemented screening measures, provided necessary PPE and taken additional steps to help ensure the safety of our staff. None of our employees have said they were scared to come back to work. We have been able to transition five administrative positions to work from home and gave a few other staff members the flexibility to work from home back in March and April.”