As technological advancements make more procedures appropriate for the outpatient setting, surgery centers are looking to add more complex procedures than they have performed in the past. Lori Vernon, RN, regional vice president of operations for Health Inventures, discusses seven steps surgery centers should take prior to adding a more complex procedure.
1. Educate the ASC board on the risks. Ms. Vernon says surgery centers should start by educating the center's governing board on the clinical and financial risks of the new specialty or procedure. "From a governance standpoint, you have to have board support," she says. Explain how the surgery center will assure the physician is competent to perform the procedure, select appropriate patients, prevent adverse outcomes and react if an unexpected issue arises. In addition, go through the financial details involved with the procedure, including expected reimbursement, supply and staffing costs and case volume necessary to ensure profitability.
2. Examine patient selection criteria. Complex procedures are usually appropriate for a smaller pool of patients, meaning ASCs adding a complex procedure should review patient selection criteria to determine who is eligible for surgery. For example, some procedures will not be appropriate for patients with several co-morbid conditions, high BMI or a history of cardiac problems. Physicians should be educated on patient selection criteria so they can recommend the procedure to appropriate patients prior to scheduling the case at the ASC.
3. Develop a plan for patient education. More complex procedures may involve longer recovery times, more significant pain or other issues that affect the patient experience. The center should develop verbal and written education that explains the details of the procedure and gives instructions for post-operative care. "You need to develop a comprehensive plan that prepares and educates patients and provides discharge information. "This should begin in the physician's office at the time the procedure is contemplated to be done on an outpatient basis." Ms. Vernon says. "This is essential when adding a service line of increased complexity."
4. Speak to anesthesiologists about pain management. "With the increased ability to manage pain in a variety of ways, more procedures can be done in the outpatient setting," Ms. Vernon says. Anesthesiologists will need to understand the new procedure so they can tailor anesthetic care to most effectively manage post-operative pain.
5. Establish staff competencies. Make sure that staff members are competent to assist the physician with the procedure before introducing it to the surgery center. Staff should understand what the procedure is, how it will be performed and which instruments will be required. If staff members need additional training to perform the procedure, the center can use an experienced staff member to educate other members of the team or send nurses away for training.
6. Incorporate home health. Ms. Vernon says surgery centers often forget to incorporate home health into planning for a new procedure. "I think we should access home health as much as we can," she says. "Make sure you are working with the physician office to develop a plan for home health visits that the patient's insurance may pay for." She says the patient's insurance may allow the patient to be checked on at home following the procedure. Keep an open communication line with your local home health agency and notify them when you add a new procedure or specialty.
7. Start off slow. Be cautious when you start performing a new procedure at your surgery center, Ms. Vernon says. "Maybe for the first five cases, you plan to do them first thing in the morning so the patient can spend some time in recovery," she says. "That way, you can truly assess how they're doing when you discharge them." As your center becomes more comfortable with the procedure, you will probably be able to schedule more cases and discharge patients more quickly, but make sure that your staff is confident in the procedure before you scale up.
Learn more about Health Inventures.
Related Articles on ASC Operations:
6 Things to Know About Pharmaceuticals and Outsourcing Pharmaceutical Solutions
5 Traits of Highly Successful Surgery Center Directors of Nursing
Surgery Center Administrator Recruitment Checklist: 13 Questions to Ask Candidates
1. Educate the ASC board on the risks. Ms. Vernon says surgery centers should start by educating the center's governing board on the clinical and financial risks of the new specialty or procedure. "From a governance standpoint, you have to have board support," she says. Explain how the surgery center will assure the physician is competent to perform the procedure, select appropriate patients, prevent adverse outcomes and react if an unexpected issue arises. In addition, go through the financial details involved with the procedure, including expected reimbursement, supply and staffing costs and case volume necessary to ensure profitability.
2. Examine patient selection criteria. Complex procedures are usually appropriate for a smaller pool of patients, meaning ASCs adding a complex procedure should review patient selection criteria to determine who is eligible for surgery. For example, some procedures will not be appropriate for patients with several co-morbid conditions, high BMI or a history of cardiac problems. Physicians should be educated on patient selection criteria so they can recommend the procedure to appropriate patients prior to scheduling the case at the ASC.
3. Develop a plan for patient education. More complex procedures may involve longer recovery times, more significant pain or other issues that affect the patient experience. The center should develop verbal and written education that explains the details of the procedure and gives instructions for post-operative care. "You need to develop a comprehensive plan that prepares and educates patients and provides discharge information. "This should begin in the physician's office at the time the procedure is contemplated to be done on an outpatient basis." Ms. Vernon says. "This is essential when adding a service line of increased complexity."
4. Speak to anesthesiologists about pain management. "With the increased ability to manage pain in a variety of ways, more procedures can be done in the outpatient setting," Ms. Vernon says. Anesthesiologists will need to understand the new procedure so they can tailor anesthetic care to most effectively manage post-operative pain.
5. Establish staff competencies. Make sure that staff members are competent to assist the physician with the procedure before introducing it to the surgery center. Staff should understand what the procedure is, how it will be performed and which instruments will be required. If staff members need additional training to perform the procedure, the center can use an experienced staff member to educate other members of the team or send nurses away for training.
6. Incorporate home health. Ms. Vernon says surgery centers often forget to incorporate home health into planning for a new procedure. "I think we should access home health as much as we can," she says. "Make sure you are working with the physician office to develop a plan for home health visits that the patient's insurance may pay for." She says the patient's insurance may allow the patient to be checked on at home following the procedure. Keep an open communication line with your local home health agency and notify them when you add a new procedure or specialty.
7. Start off slow. Be cautious when you start performing a new procedure at your surgery center, Ms. Vernon says. "Maybe for the first five cases, you plan to do them first thing in the morning so the patient can spend some time in recovery," she says. "That way, you can truly assess how they're doing when you discharge them." As your center becomes more comfortable with the procedure, you will probably be able to schedule more cases and discharge patients more quickly, but make sure that your staff is confident in the procedure before you scale up.
Learn more about Health Inventures.
Related Articles on ASC Operations:
6 Things to Know About Pharmaceuticals and Outsourcing Pharmaceutical Solutions
5 Traits of Highly Successful Surgery Center Directors of Nursing
Surgery Center Administrator Recruitment Checklist: 13 Questions to Ask Candidates