In our ongoing series, Becker's ASC Review spoke with AAAASF’s Associate Director of Accreditation Jeanne Henry about the organization's commonly cited deficiencies related to the transition from paper to electronic surgical logs.
Jeanne Henry: As many ASCs transition from paper to electronic records, AAAASF surveyors often find the transition to electronic surgical logs is incomplete. These circumstances frequently lead to a number of related deficiencies. The resulting citations can occur under any one or several of the standard items ranging from 600.040.001 to 600.040.009. AAAASF Standards require a surgical log of cases be maintained, either in a hard copy bound log with sequentially numbered pages, or in a secured computer log. The surgical log must include each of the following elements: Sequential numerical listing of patients, date of surgery, patient’s name and/or identification number, procedure(s)/surgery(s), surgeon’s name, type of anesthesia, name of person(s) administering anesthesia, and the person assisting the surgeon (MD, PA, RN or scrub tech).
AAAASF standards require the surgical log to be adequately tamper proof. If a paper log is maintained, it must be bound in a manner that does not allow the removal of individual pages. AAAASF recommends the log book to be gum-bound. Gum-bound surgical logs may be purchased through a medical supply company. If you prefer to use your own customized format, you may have your materials gum-bound at any office-supply store. A three-ring binder is not an acceptable method of maintaining a surgical log. The pages of the surgical logbook must be sequentially numbered which allows you to identify if a page has been removed.
Each entry in the surgical log must include sequential numbering of patients, beginning with either the first case performed in the facility or recording the entries starting new each year. This system helps identify the total number of cases conducted in a given period. Sequential numbering is also an important tool for ensuring each patient and case is recorded for infection tracking and other quality purposes.
ASCs that have fully transitioned to an electronic surgical log face a different set of challenges. The log must contain the same data points as discussed above and must be housed in a secured manner that prevents tampering. Electronic surgical logs often present a bigger challenge than paper logs. With today’s ever changing technological landscape, AAAASF understands that the manner of securing the electronic log may vary from one facility to the next.
Many facilities default to the use of Microsoft Excel, or similar spreadsheet programs, to house their electronic log because it is a common and familiar program for most staff. However, Excel is easily manipulated allowing users to delete entries without any record. Additional protections must be in place to protect the data contained in the surgical log. Some acceptable forms of security may include password protecting the spreadsheet, limiting users’ rights to prevent editing or deletion, locking out the computer on which the log is kept or instituting physical deterrents such as locking doors to areas that house computer software.
Other systems, such as EMR systems, create an audit trail that automatically records any changes to the entries.
Surveyors commonly find that facilities intend to use scheduling software as a substitute for the surgical log. This is also not an acceptable log for the purposes of compliance. Scheduling software is intended to project cases and typically allows users to delete or otherwise modify the calendar. For example, administrators may move subsequent cases up in the schedule if a previous case is abandoned.
The surgical log serves the very different purpose of providing an accounting of every patient that enters the operating room. Thinking of the surgical log as the control mechanism for recording each patient entering the operating room will help facilities establish a template and a process that meets their operational needs while still providing the patient the intended protections.
