This article is written by Tina Madonia Mentz, Executive Director of Elmhurst Outpatient Surgery Center. Increased regulatory scrutiny, primarily resulting from recent high profile cases spotlighting safety issues, is placing incredible strain on ambulatory surgery centers, from both a financial and operational standpoint. The infinite amount of medical content on the Internet has created more informed consumers. Our patients understand what questions to ask to ensure the ASC they visit is deemed "safe." In their quest for a safe facility, accreditation is often the first priority. Accreditation is an important element of safety and a screening tool for many payers. However in 2013, that is not enough for an ASC to demonstrate its commitment to patient safety. Providing a safe environment is not only good for the patient, it is good business.
At Elmhurst Outpatient Surgery Center, a multispecialty surgery center in suburban Chicago, we continually look for ways to provide the safest environment for our patients. Here are some examples of our successes:
1. Don't overlook the basics. Patient safety initiatives don't have to be complex. Something as simple as a "repeat back" policy can be a highly effective way to improve patient safety as it ensures everyone on a surgical team is on the same page. In addition to being easy to implement, it is free.
Requiring staff to visualize site markings and verbally repeat back laterality, digits or other critical procedural information ensures there is no confusion or miscommunication. For technology-assisted surgeries such as femtosecond laser cataract and astigmatism correction procedures, our staff reads from the surgeon's treatment plan while the surgeon and surgical assistant visualize and repeat back the parameters that were pre-loaded into the system.
2. Be proactive. We implemented a surgical safety checklist three years before Medicare required a surgical safety checklist to be in place. We did so because it made sense. It promoted safety, efficiency and ensured a positive patient experience.
When you develop a good process you want to make sure there are checks and balances and that you are doing it the same way every time. Consistency elevates a facility's ability to provide a safe environment. With a surgical safety checklist in place we can ensure staff are following all the necessary steps every time to ensure safety.
3. Ensure effective communication. The ability to effectively communicate with patients eliminates confusion and increases patient compliance. Leveraging different modes of communication helps ensure critical informationis not overlooked. In addition to our patient brochure and pre-surgical information posted on our website, we utilize a mobile messaging service to communicate important information to patients prior to and after their procedures.
Through mobile messaging, we confirm the procedure date and arrival time, direct patients to complete their on-line medical history, and provide other valuable reminders such as what to bring on the day of surgery (e.g., picture ID, insurance card and a responsible adult driver), restrictions on eating/drinking or even special preparation instructions for colonoscopy cases. Our mobile first initiative doesn't take the place of our nursing staff; it enhances the pre-surgical instructions provided by our nurses to ensure a greater level of patient compliance.
Post-procedure, we conduct a brief patient satisfaction survey. We are also exploring ways to expand the use of our mobile messaging service to assist with post-surgical care. Our goal is to send patients appropriately timed messages that support the education we provided prior to discharge. In addition to increasing patient safety and compliance, this may help minimize the number of post-procedure calls placed to the surgeon.
4. Get your patients involved. This should be obvious, however we as an industry sometimes fail to consider the value that patients can bring by being involved in every step of process. Phoning patients in advance of a procedure to gather medical histories is resource intensive. Since patients are not expecting the call, they are often unprepared and rushed.
We deployed One Medical Passport, an online pre-admission solution, which enables patients to enter their medical and surgical history online at a time and place that is convenient for them. Because they have the necessary information in front of them when filling in their medical histories, information is more accurate and complete. Rather than spending time playing phone tag with patients and manually inputting responses, nurses now have time to review information provided by patients and follow-up as needed. To ensure important medical information is not missed, One Medical Passport has an alert feature which flags high risk factors which may require additional follow-up.
It is important to remember that creating a safe environment doesn’t have to result in more paperwork or complex processes. When you create a complex process, short cuts may happen which can compromise the efficacy of the system. A simple, streamlined approach is critical to achieve staff compliance. The goal is to implement a process that meets the needs of your patients. The process must be executed the same for every case; consistency will result in success.
Treat your patient safety processes like any other business process. It must be continuously refined and retuned. By doing so, you can create a safe environment and a superior patient experience!
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