There are a number of reasons why physicians aren't typically spearheading accreditation efforts in ambulatory surgery centers, although most of those reasons are not necessarily bad ones. Sheryl Walker, MD, a surveyor for the Accreditation Association for Ambulatory Health Care, explains that ASC accreditation is typically quarterbacked by administrators or nursing directors because physicians are extremely busy with patients.
"Another reason is because physicians in ASCs often experience such good outcomes and success, so there is often a disconnect between why policies and procedures are put into place," Dr. Walker says. Still, it's important for ASCs to involve physician in accreditation processes, whether that means updating processes and procedures or including them in the preparation stages for an upcoming survey. Dr. Walker outlines four ways ASCs can better involve their physicians in these efforts.
1. Explain the worst that could happen. ASCs are known to have markedly good outcomes and infection rates, so in order to stave off complacency about patient safety issues, Dr. Walker says ASCs should remind physicians why patient safety processes and procedures are put in place.
"If ASC physicians understand how easily a terrible patient safety event could occur, the buy-in to the processes and procedures will be easier," Dr. Walker says. "It has a huge impact to hear what happened to colleagues or patients and makes you stop and think about what you are doing."
In one example, Dr. Walker describes a time when a patient visited her surgery center with third-degree burns all over her leg. After some questioning and examination, Dr. Walker discovered the patient incurred the burns because another facility used an expired grounding pad on an electrosurgical unit that was no longer effective in preventing the thermal injury from occurring. "What we do everyday in the OR is life threatening, it's just that we do it under controlled circumstances," Dr. Walker says. "We must always remember just how easy it is to have things go horribly wrong."
2. Explain why certain processes and procedures are put in place. Dr. Walker says ASC physicians may demonstrate some resistance to changes in processes and procedures they seem unnecessary when great quality outcomes are already being achieved. However, it is important to tell physicians that processes and procedures must sometimes be changed or revised to achieve a higher level of patient safety.
"For example, at our surgery center, we implemented electric green-colored antibiotic order sheets so that when it comes time, we are absolutely sure the right antibiotic is being administered to the right patient at the right time," Dr. Walker says. "The goal is not to make physicians miserable. The goal is actually to make it easier for them."
3. Involve physicians in decision-making processes. Whenever an ASC takes on a new initiative to change a patient safety-related process or procedure, it's always a good idea to keep physicians in the loop about those changes. Dr. Walker says when CMS released the new conditions for coverage in 2009, the surgery center's quality improvement committee worked on a plan of action but, as a last step, took it to the board of physician-owners.
"We went to the board with our plan of action on how to tackle the new conditions for coverage and asked them if they had any suggestions for the plan," Dr. Walker says. "After asking for their input, they were happy with the action plan and understood how it would work for our facility."
4. Be diligent with documenting physician involvement in ASC activities. Accreditation standards require ASC physicians to document their involvement in all ASC activities, such as peer reviews of medical charts and facility governance. Although physicians are held to that standard, the underlying theme to reinforcing, encouraging and maintaining physician involvement in patient safety-related processes is accountability, Dr. Walker says.
Thank you to AAAHC for arranging this article.
Learn more about AAAHC.
"Another reason is because physicians in ASCs often experience such good outcomes and success, so there is often a disconnect between why policies and procedures are put into place," Dr. Walker says. Still, it's important for ASCs to involve physician in accreditation processes, whether that means updating processes and procedures or including them in the preparation stages for an upcoming survey. Dr. Walker outlines four ways ASCs can better involve their physicians in these efforts.
1. Explain the worst that could happen. ASCs are known to have markedly good outcomes and infection rates, so in order to stave off complacency about patient safety issues, Dr. Walker says ASCs should remind physicians why patient safety processes and procedures are put in place.
"If ASC physicians understand how easily a terrible patient safety event could occur, the buy-in to the processes and procedures will be easier," Dr. Walker says. "It has a huge impact to hear what happened to colleagues or patients and makes you stop and think about what you are doing."
In one example, Dr. Walker describes a time when a patient visited her surgery center with third-degree burns all over her leg. After some questioning and examination, Dr. Walker discovered the patient incurred the burns because another facility used an expired grounding pad on an electrosurgical unit that was no longer effective in preventing the thermal injury from occurring. "What we do everyday in the OR is life threatening, it's just that we do it under controlled circumstances," Dr. Walker says. "We must always remember just how easy it is to have things go horribly wrong."
2. Explain why certain processes and procedures are put in place. Dr. Walker says ASC physicians may demonstrate some resistance to changes in processes and procedures they seem unnecessary when great quality outcomes are already being achieved. However, it is important to tell physicians that processes and procedures must sometimes be changed or revised to achieve a higher level of patient safety.
"For example, at our surgery center, we implemented electric green-colored antibiotic order sheets so that when it comes time, we are absolutely sure the right antibiotic is being administered to the right patient at the right time," Dr. Walker says. "The goal is not to make physicians miserable. The goal is actually to make it easier for them."
3. Involve physicians in decision-making processes. Whenever an ASC takes on a new initiative to change a patient safety-related process or procedure, it's always a good idea to keep physicians in the loop about those changes. Dr. Walker says when CMS released the new conditions for coverage in 2009, the surgery center's quality improvement committee worked on a plan of action but, as a last step, took it to the board of physician-owners.
"We went to the board with our plan of action on how to tackle the new conditions for coverage and asked them if they had any suggestions for the plan," Dr. Walker says. "After asking for their input, they were happy with the action plan and understood how it would work for our facility."
4. Be diligent with documenting physician involvement in ASC activities. Accreditation standards require ASC physicians to document their involvement in all ASC activities, such as peer reviews of medical charts and facility governance. Although physicians are held to that standard, the underlying theme to reinforcing, encouraging and maintaining physician involvement in patient safety-related processes is accountability, Dr. Walker says.
Thank you to AAAHC for arranging this article.
Learn more about AAAHC.