Nicholas B. Frisch, MD, MBA, is an orthopedic surgeon specialized in hip and knee replacement. Dr. Frisch performs inpatient cases at Ascension Crittenton Hospital in Rochester, Mich., and outpatient cases at Michigan Institute for Advanced Surgery in Lake Orion, Mich.
Here are his five best practices for ensuring patient safety in ASC and outpatient settings, edited for length and clarity.
1. Assessment. The most important part of the process is identifying patients who are safe candidates for outpatient surgery. There are several different criteria to consider. Everything starts with a comprehensive review of medical comorbidities, and in my practice, we maintain a close collaboration with my primary care and family practice colleagues, realizing when to engage additional specialists (i.e. endocrinology, rheumatology, cardiology, etc.).
Once patients are cleared medically, I think it's equally important to review them socially to determine if they are reasonable outpatient candidates. Some patients lack support at home, and others have a living situation that is not conducive to going home the same day. So, part of our job is to identify these factors. I've started leveraging [the digital platform] PeerWell to help me with this part of the process. It follows the patient from PreHab to ReHab. I can see which of my patients are signed up for PeerWell, but perhaps more importantly, how engaged they are in the program.
There have been specific instances where I've had a patient cleared medically, but I just wasn't convinced they would be a great candidate for outpatient. That subjective feeling is challenging to manage as a surgeon, but PeerWell has allowed me to quantify a large part of that through evaluation of each patient's actual engagement in the program.
2. Preoperative education. If they are cleared medically for outpatient surgery, then preoperative education is the next step. We approach this from a variety of different ways to appeal to every individual patient's learning style. We have printed material that we provide for every patient, we have a preoperative joints class taught by one of our physician assistants, and our website, FrischOrtho.com, is designed to provide basic information on joint replacement as well as [resources like] questions/answers, short videos and animations. In addition, we provide several links to other resources we believe are unbiased.
3. Targeted information. Once a patient is signed up for surgery, they are enrolled in PeerWell, which provides targeted information to the patient. The program starts preoperatively (PreHab) and continues post-operatively (ReHab). Finally, we routinely schedule a preoperative visit specifically to answer any questions or concerns prior to surgery.
4. Communication. Moving from an inpatient setting to a true ambulatory setting in a freestanding ASC requires more than just showing up and operating. To ensure patient safety, there needs to be a process of checks and balances that follows the patient through the process as well. PeerWell continues to engage the patient throughout the process and provides one avenue for communication. We contact the patient routinely the day after surgery and at set intervals post-operatively. Additionally, our anesthesia team monitors the patient postoperatively, often through phone calls to ensure no complications associated with anesthesia.
5. Accountability. Whether inpatient or outpatient, it is important to review successes and complications on a regular basis. Every center is different but we break this down to the individual surgeon level and review. When we encounter an issue, there is a process for acknowledging the issue, critically evaluating any systemic failures and implementing a plan to avoid in the future.
