ASC Durango (Colo.) recently underwent its first AAAHC survey and achieved accreditation. Cheryl Desko, RN, clinical director for the ASC, discusses three quality assessment and performance improvement studies which were praised by surveyors.
1. PACU times. "We tracked our PACU times and found that we had some [patients] extended beyond four hours and broke that down to determine why they were staying longer," says Ms. Desko. Some of the patients staying longer than four hours were by doctor's choice, which the ASC couldn't change. But the surgery center lacked a PONV protocol, which was developed and helped reduce the time.
"We also didn't have what we felt was an accurate discharge criteria policy, so myself and my medical director sat down and developed this policy," she says. "It's now not up to the nurses for when the patients go home, it's when the patients meet the discharge criteria." Once that happens, an anesthesiologist evaluates the patient and confirms that they've met the ASC's criteria for discharge.
2. More extensive case cost analysis. The ASC, with efforts spearheaded by Sandy Williamson, director of business for the surgery center, analyzed its 25 top cases and then broke them down further to compare reimbursement from different payors so as to educate surgeons about the surgery center's top payors.
The ASC took analyzing the data one step even further and compared each surgeon's costs to other surgeons in the same specialty. "For example, we looked at why one orthopedic surgeon was [costing] so much more for ACLs versus another doctor," Ms. Desko says. "We could compare [those costs] and show those to our owners. Now we have a more standardized inventory with the doctors using pretty much the same supplies. We did this for orthopedics and also general surgeons as far as different meshes and different supplies they use for hernia supplies. We were able to show them the differences in what their paid costs were."
3. Post-op surgical infections. "We studied post-op surgical infections and found that the majority of them were [associated with feet surgery]," said Ms. Desko. "I've done more research into it and we've now standardized how we do our prep and get patients ready for foot surgery. This is ongoing."
Learn more about ASC Durango.
Read more accreditation ideas for improvement:
- Critical Steps to Improving Medical Records: Q&A With Dr. James Leavitt of Galloway Endoscopy Center
- 4 Best Practices for Maintaining Accreditation
- Guidance to Develop Better Quality Improvement Activities: Insight From AAAHC Surveyor Gayle Lowe