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The result, he says, is that each person knows the importance of each function and understands each role they may be assigned on any given day. "Having staff who can recognize and step in to deal with the little differences each day that can clog the sys- tem is invaluable," he says. Mr. Horowitz points out cross- trained staff are versatile enough to manage issues related to high blood pressure, discrepancies in paperwork, lens choices, tough IV starts and equipment chal- lenges. Many different personnel of varying backgrounds can step in to address each of these evolv- ing issues so they can be resolved, and patient flow goes on seemingly uninterrupted. "We all like each other and enjoy the work we do to improve the lives of our patients," says Mr. Horowitz. "Are there occassional stresses? Of course. But having a well-trained, well-choreo- graphed and competent team eases them immensely." 3. Think systematically Mr. Horowitz has been assisting in eye surgeries for many years. "A central component to efficiency — which, in addition to high-quality care, leads to prof- itability — is the development, use and evolution of a system that can be repeated over and over," he says. "I only see the perioperative portion of the practice, but there are a ton of moving parts, many in the background, that allows us to function so well. Whether it's patient throughput for exams and evaluations on the office side, or perioperative throughput, it involves a highly coordinated group of committed people to make it work." He adds that with an effective system in place, the cataract surgeon is much better able to simply focus on their job, which, at the end of the day, is the most important thing happening in your center. The delicate balancing act of having enough sup- plies — but not too many — on hand is even more difficult in a high-volume cataract surgery center. "Our director of nursing works hard to make sure all of our supplies are used prior to expiration dates, and to ensure that no items are over- ordered," says Dianna Reed, BA, administrator at Sani Eye Surgery Center in Templeton, Calif. "We have all the supplies needed for certain types of cases grouped together. For a cataract surgery, a staff member grabs all needed supplies for the next case in one place." Her facility uses custom packs, which contain the bulk of supplies needed for cataract proce- durees, so a nurse needs to simply grab only a cou- ple additional items between cases. "We keep items used on occasion, such as trypan blue for cataract surgery, in OR storage, so the circulator doesn't have to leave the room," explains Ms. Reed. "We also keep CRNA supplies in a locked toolbox with six drawers in the OR, so needed supplies are always on hand." 5 6 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 2 0 EXPERT AT WORK High-volume surgeons such as Hunter Newsom, MD, want to focus on working quickly and safely.