The Daily Adventures of Managing Surgery

A Scrub's Life

A Scrub's Life

The Daily Adventures of Managing Surgery

Recent Posts

We interrupt our regular blog post….

To my blog readers: I had planned on sending a blog to you about surgical leadership this week…but couldn’t.  You see, my family lives in Houston.  My mom, stepdad, brother, sister-in-law and nephew…are all there.  I have been feeling both distracted and helpless all week […]

My recent plumbing challenge… and what it taught me about time management.

I had a recent shower plumbing problem that was causing bathroom sharing woes in my household. I decided to hire a handyman who had done work for me in the past.  I trusted he would do a great job as at a reasonable price. I […]

Helping you prepare for emergency prep compliance: practical ways to communicate in an emergency, and build your Alternate Communication Plan


It’s hard to think about “alternate” communication.  We are always communicating.  We are constantly receiving texts, emails, and phone calls.  Now CMS wants us to have an alternate plan, when we can barely keep up with regular communication.

If you consider, however, as much as we are bombarded, what if we couldn’t?  What if our computers had no power, we couldn’t get to our e mails, and our cell phones were dead.  Would you even know how to find numbers?  What about reaching loved ones?

When we consider alternate communication, it’s a good idea to think in scenario based terms.  Here are some to consider:

You can’t get to your center, and/or need to communicate that the center is closing due to an emergency.  How will you reach your staff, physicians and patients?  Consider how you can access your schedule offsite.  If you store it electronically, can you access remotely?  If not electronically stored, do you bring home a copy of the following day’s schedule?  As part of your plan, decide how you will access patient information for contacting them in the event of an emergency.  I’ve had physician illnesses and family emergencies, power outages and ice storms to contend with at early hours of the morning.

Can you reach your staff easily and effectively?  I love the GroupMe app.  All facility staff are part of the group and you can text instructions and/or notifications to everyone at once.  It is much easier than texting one at a time, especially when there is a lot of information to share.  As an example, if the facility has no power, you send a GroupMe text, letting everyone know that the facility is closed until power is restored and to standby for further information.

What if you have no cell phone?  There are many numbers I don’t know because I can easily find them in contacts.  Back up and print your contacts so that you can access if your phone is dead. Better, yet, you may want to consider a battery based charging system and chargers as part of your plan.  Amazon has a portable power bank for less than $20.00. If you want to learn more, you can find it here.

You may want to keep a current staff list handy that includes e mails and emergency contacts.  I once had an employee not come to work who was very dependable, and I had no emergency contact person listed in her file.  I ended up contacting police to do a wellness check that we later learned was a family emergency.  Lesson learned from stress and concern.

What if there is no cell service? You may want to consider GoTenna, which allows communication when service is unavailable, and works with most messaging apps. Messages are sent via Bluetooth from the phone which then converts the message that can be sent over radio signals to users, who must also be using the GoTenna. Messages can be sent to groups, and location information can be sent to contacts already in the phone without a signal.   You can also find on Amazon for less than $125.00, which is well worth it if you have no service.  To learn more about GoTenna, you can find it here.

There are great information apps available as well.  NOAA, The Red Cross, or local news stations offer apps.  They won’t help you communicate, but they will keep you informed during an emergency.  Once you have decided on what works best for your facility, don’t forget to put it all in a policy, and update the staff.  You’ll satisfy a CMS requirement, and have a solid plan complete.


10 Things I wish I had learned as a Leadership Newbie

10 Things I wish I had learned as a Leadership Newbie

If you remember when you were a leadership newbie (or if you are), did you have a mentor to show you the ropes, or were you “baptized by fire”? I was recently discussing the challenges I faced as a new ASC leader with a colleague. […]

My top 10 infection control survey blunders…they may be yours too!

My top 10 infection control survey blunders…they may be yours too!

I have the privilege of assisting surgical facilities prepare for surveys.  I have seen countless wonderful, clean, well prepared centers where I would feel confident in having surgery or taking a loved one for surgery. Even in the most pristine facilities, there is sometimes an […]

How I survived my recent unannounced State Survey

How I survived my recent unannounced State Survey


I trust you know the drill….you are sitting at your desk, working away, dealing with the issues of the day, and your front office staffer comes to your doorway with a business card in hand.  Nope, it’s not a rep…it is a surveyor, and your day just radically changed.

Even the most organized ASC leader probably has the same response.  Your heart rate goes up a notch, you get that feeling of dread, and you close whatever you’re doing to go introduce yourself to the waiting surveyor and what the day will bring.

A couple of weeks ago, this was me.  If you don’t know, I help manage an ASC part time, when I am not providing support to new and existing centers.  I felt all those “feels” I mentioned, and went to meet the surveyor to start my new day’s path.  I then escorted the surveyor to the conference room, had the entrance interview, and got to work.

For the next two days, I pulled out and put back binders, located policies, answered questions, toured the facility, and reviewed medical records.  When all was said and done, I sat down for my exit interview, pen in hand and waited to hear about potential deficiencies.  There were none.  I escorted the surveyor out and literally did a “happy dance” in the hallway out of sight.

Here are some of the things I did that you might find helpful:

  • I put my binders on the table in alphabetical order, binders facing the surveyor.  She actually commented that she liked the arrangement, making it easier to locate what she needed.
  • I flagged key documents and policies with sticky tabs for easy reference.
  • I checked in every half hour to answer questions and provide clarification during the document review process, but I didn’t hover.
  • When I was unsure of an answer or not clear on a recommendation, I asked for clarification.
  • I kept the staff in the loop, and asked for help when I needed it. I used our “groupme” app to communicate what was going on to the staff.  (We installed the app and set up our center as a group as part of our disaster preparation plan for alternative communication).

Being organized was key.  I could tell that, when the surveyor asked for specific documents, she was pleased that I was able to locate them easily.  I feel like the process became more congenial once I established the fact that I knew where “stuff” was.  I also sent messages to the staff during the process through the “groupme” app with reminders like “wash hands/check bands!”

I’m really glad the process is over, and that our hard work and organization paid off.  I keep everything up to date by maintaining a calendar that I title “compliance calendar” in which I maintain all actions and documents required for compliance by frequency and date.  I also have an online toolkit I named “AccrediReady” that I use for myself as well as my clients that is a visual project management tool for easy compliance readiness.  If you would like more information on either, feel free to reach out to me.

I hope your next survey, whether announced or unexpected goes swimmingly, as well as your summer.


This is not a drill! It’s a plan and a CMS rule……what the CMS Emergency Preparation Rule means, and tips for compliance.

This is not a drill! It’s a plan and a CMS rule……what the CMS Emergency Preparation Rule means, and tips for compliance.

    As you may be aware, CMS added a new regulation for all Medicare suppliers including ASC’s, requiring very specific actions for Emergency Preparedness, known as the EP rule. The rule requires all of us to comply by November 2017.  At first, my thought […]

Sometimes we can be a little tone deaf…

Sometimes we can be a little tone deaf…

  Do you know how some days just take on a vibe of their own? Like the days when everyone is working together as a team, smiles are all around, the cases are all going great and the patients all happy and kind?  Or those […]

Six things I would love to tell my patients…..

Six things I would love to tell my patients…..

Interacting with patients and their families can be very rewarding. Most are kind, grateful for the care we provide, and responsive to our instructions. Effectively communicating with patients can sometimes be challenging, and patients may say and do things that add to these challenges.

Here are six things I’d like to say to patients, as well as some steps that may help avoid saying them.

We love a good sense of humor, and also love sharing banter with you as we prepare you for surgery.  However, please do not tease about the stuff that matters:  what we are doing for you today, when you last ate  or drank, or other critical questions that require serious answers.

Sometimes, a simple…”these next three questions I require your attention as part of our safety process” may get the message across. 

Please tell your caregiver to dress warmly and bring an activity to pass the time.   For them, much of the time in our center will be both boring and cold, and we can’t fix that.  We hate it when they look cold and miserable, and our bath blankets are in limited supply.

Include caregiver expectations as part of the pre-op teaching process.  Something like “It tends to be cold and boring for caregivers here, so instruct them to dress warmly and bring something to do” . 

I wish we were not running late.  It is something we hate, and do everything to prevent it.  Once we are behind, however, we cannot fix it.  You would not want us to rush anything for your care, and we won’t do it for others either.

On late running days, I try to keep everyone updated, both in pre-op and in the lobby.  Proactive communication prevents some of the frustration.  Sometimes, a reminder to the the patient that they wouldn’t want us to rush their care helps.

NPO means NPO.  Please follow our fasting  guidelines.  It is not just an inconvenience for you, it may impact your safety.  A little food prior to surgery is not worth a hospital transfer and pneumonia or worse.

When providing NPO instructions prior to surgery, including that the reason is for their safety, which may mprove compliance.

We don’t judge you if you smoke. However, it will slow your healing and impact your post operative course.  Also, please don’t smoke as much as possible prior to arrival, as the smell stays with you and impacts others.  Same with perfume and cologne.  Even our “nurses noses” are impacted when overdone.

Including the no smoking or fragrances as part of the pre-op teaching.

Please don’t give us your driver’s license weight.  I know mine lists my goal weight.  We won’t tell anyone, and if we were good at guessing, we’d have joined the carnival.  We use your weight to make decisions about medication dosages and equipment safety.

Include weight measurement as part of the pre-operative process prior to surgery.

Do you have honest advice you would love to share with patients?  I would love to hear them!  Please share in comments, or send me an e mail at  Thanks!




The grass isn’t always greener…

The grass isn’t always greener…

When I was little, I lived in a small suburb in western New York with my mom, dad, and little brother.  We didn’t have much, but I didn’t really notice.  My dad had an adventurous spirit, which lead to weekend drives that led to places unknown, […]