What We Do:

More and more often, patients are receiving their surgeries in an outpatient setting – returning home the very same day as their surgery! Receiving surgical care as an outpatient has many advantages including the comfort of recovering in familiar surroundings, early post-operative mobilization, and reduced healthcare costs. The Ambulatory Anesthesia Division provides anesthetic care for the Johns Hopkins Outpatient Center (JHOC) for patients who return to their homes on the day of surgery. The Ambulatory Anesthesia Division supports many surgical specialties including orthopedics, plastics, gynecology, and otolaryngology, vascular, urological, endocrine, and general surgery. The Outpatient Center includes eight operating rooms that benefit from being directly on the same campus as the Johns Hopkins Hospital should a patient need hospital-based services.

ACCM Brings Dynamic Work Design to JHOC with the Help of M.I.T. and ShiftGear Collaboration

The volume of surgeries occurring in the ambulatory setting has been steadily increasing over the past decades. In 2015, nearly 5,500 Ambulatory Surgery Centers treated 3.4 million Medicare patients for a program and beneficiary spending of $4.1 billion [Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. Washington DC March 2017]. With the increased number of cases, efficiency in ambulatory surgery centers has been a major focus which helps to achieve the patient- and family-centered goals of outpatient surgery and anesthesia – specifically, having patients safely discharged to home in a timely manner and allowing them to return to normal daily function as soon as possible.

In August, 2017, Don Kieffer and his team from the Massachusetts Institute of Technology and ShiftGear came to JHOC to apply their system of Dynamic Work Design (DWD) to the flow of the operating room suites. For a week, they observed how surgeries were performed and took a deep dive into how and why tasks were performed in a certain way. Their goal was to help design work that optimized the biggest asset in JHOC – the staff. They applied four principles: aligning activity and intent, connecting the human chain, structuring problem solving and creativity, and managing optimal challenge to the system. Their report clearly found a center of excellence for perioperative care, however, there were several opportunities for improvement regarding scheduling, handoffs, and coordination/ownership of tasks.

One of the key areas will be increasing the number of on-time first case starts. We will be designing a user-friendly status board to implement clear signals that indicate patient readiness for the operating room and also provide the proper channels for escalation when problems arise. Another area of concentration will be turnover time through clearly designating responsibility/ownership of tasks and patient transfer to the OR, and improving visibility of turnover progress to all parties. We are excited to apply and refine these workflow improvements in JHOC and use them as best practices for the Greenspring Station Ambulatory Surgery Center which opens in 2018.

Division Faculty and Clinical Associates

Sara Sateri, MD
Division Chief, Ambulatory Anesthesia

Deondra Asike, MD

Robert Brown, MD, MPH

Laura Elizabeth Wong Chin, MD, MPH

Kristin Cheung, MD
Perioperative Liaison

Archana Hudson, MD, ScM

Dahlia Naqib, MD
Ambulatory Regional Program

Ed Nguyen, MD
Medical Director, Johns Hopkins Outpatient Surgery Center

Rashmi Prasad, MD
Co-Director, Ambulatory Regional Program

Stephanie Vecino Rais

Giulia Sikorski, MD
Director of Ambulatory Anesthesia Education

Tracey Smith-Stierer, MD
Vice Chair, Quality, Safety, and Service

Jerry Stonemetz, MD
Medical Director, Preoperative Services
Medical Director, Center for Perioperative Optimization

Clarissa Tomeldan, MD
Medical Director of Wellness

Ambulatory Anesthesia CRNA

Kelly Rechtin
Ambulatory Lead CRNA