“Eliminating risk is impossible…what is so important is identifying and managing the risk at your ASC.”
So said Carol Hiatt, RN, a consultant and accreditation surveyor for Healthcare Consultants International, during an Oct. 24 session at the 20th Annual Ambulatory Surgery Centers Conference in Chicago.
More and more high-acuity patients have been coming to ASCs recently, said Ms. Hiatt. The low-cost setting is attractive both to patients and payers, and infection and complication rates tend to be more favorable. However, as cases previously performed in hospitals are being moved to the outpatient setting, the risks increase with a greater potential for major adverse outcomes.
During the session, she offered four steps for mitigating risk for higher-acuity procedures.
1. Establish patient selection criteria. Ms. Hiatt recommended establishing set patient selection criteria, agreed upon by all key leadership from the ASC. Criteria could include factors such as any co-existing morbidities, anticipated anesthesia time, the patient’s previous surgical history or the patient’s body mass index. In addition to creating this selection criteria, “you also need to define a process for handling exceptions to the criteria,” said Ms. Hiatt.
In addition to having more rigorous patient selection criteria, Ms. Hiatt stressed the importance of creating open lines of communication so any staff member can voice a concern about a potential patient.
2. Ensure the entire ASC team is on the same page about any new procedure. After determining a risk-benefit analysis for any new procedure, a successful implementation needs the ASC leadership owning the idea. “If you can get [the] leadership team to buy in and own the idea, [you] will get buy-in from everyone,” said Ms. Hiatt. Then the leadership team should work together to ensure the entire staff is familiar, trained and comfortable with the new procedure.
3. Track complication risks. “We can all learn from our own history,” said Ms. Hiatt. “You know what you consistently do wrong, where you stumble.” She advised tracking complication rates specific to patient populations, devices and procedures to identify areas of greatest vulnerability. Following the introduction of a new procedure, she advised peer review of the first batch of cases to identify any potential complication risks.
4. Get informed consent from all patients. “Many people forget to update their informed consent with known risk” for new or high-risk procedures, said Ms. Hiatt. She advised all ASCs ensure their patient consent discloses all risks and also includes any reasonable alternatives to the procedure. Understanding the patient population is also important, said Ms. Hiatt, and ASCs should provide the consent forms in a way the patients can read and understand the information.
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So said Carol Hiatt, RN, a consultant and accreditation surveyor for Healthcare Consultants International, during an Oct. 24 session at the 20th Annual Ambulatory Surgery Centers Conference in Chicago.
More and more high-acuity patients have been coming to ASCs recently, said Ms. Hiatt. The low-cost setting is attractive both to patients and payers, and infection and complication rates tend to be more favorable. However, as cases previously performed in hospitals are being moved to the outpatient setting, the risks increase with a greater potential for major adverse outcomes.
During the session, she offered four steps for mitigating risk for higher-acuity procedures.
1. Establish patient selection criteria. Ms. Hiatt recommended establishing set patient selection criteria, agreed upon by all key leadership from the ASC. Criteria could include factors such as any co-existing morbidities, anticipated anesthesia time, the patient’s previous surgical history or the patient’s body mass index. In addition to creating this selection criteria, “you also need to define a process for handling exceptions to the criteria,” said Ms. Hiatt.
In addition to having more rigorous patient selection criteria, Ms. Hiatt stressed the importance of creating open lines of communication so any staff member can voice a concern about a potential patient.
2. Ensure the entire ASC team is on the same page about any new procedure. After determining a risk-benefit analysis for any new procedure, a successful implementation needs the ASC leadership owning the idea. “If you can get [the] leadership team to buy in and own the idea, [you] will get buy-in from everyone,” said Ms. Hiatt. Then the leadership team should work together to ensure the entire staff is familiar, trained and comfortable with the new procedure.
3. Track complication risks. “We can all learn from our own history,” said Ms. Hiatt. “You know what you consistently do wrong, where you stumble.” She advised tracking complication rates specific to patient populations, devices and procedures to identify areas of greatest vulnerability. Following the introduction of a new procedure, she advised peer review of the first batch of cases to identify any potential complication risks.
4. Get informed consent from all patients. “Many people forget to update their informed consent with known risk” for new or high-risk procedures, said Ms. Hiatt. She advised all ASCs ensure their patient consent discloses all risks and also includes any reasonable alternatives to the procedure. Understanding the patient population is also important, said Ms. Hiatt, and ASCs should provide the consent forms in a way the patients can read and understand the information.
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