Tracking and reviewing quality measures is more difficult in an ASC than in a hospital, in part because of low physician participation, the scarcity of EMR and the lack of staff. Quality control regulations will most likely be introduced for ASCs starting in 2012, and experts fear many surgery centers will be caught off guard. Beverly Kirchner, owner and CEO of Genessee Associates and a member of the ASC Quality Collaboration Group, identifies four things ASCs can do right now to start improving quality.
1. Hire a full-time quality control nurse. As the requirements for quality control get stricter, it will become necessary to hire a full-time employee to oversee quality measures and ensure your center is up to par. Ms. Kirchner, who has worked with surgery centers since 1985, says she wouldn't have believed the need for a full-time infection control nurse five years ago — but times have changed. Going forward, nurses and administrators will find it difficult to juggle their regular responsibilities with the new responsibility of tracking quality data and comparing it against national benchmarks. ASCs should first look within the organization for a nurse who seems excited about improving the center's quality. "If you've got someone who's interested and wants to learn about quality, they'll become the owner pretty quickly," she says. "If you give the task to someone who has no interest, they'll never grasp it or do a good job." If no one at your center seems eager for the position, look outside the ASC for an external hire.
Smaller centers who can't afford another full-time employee can look for a hospital nurse consultant in the area. "If you have to meet regulations, look for a hospital nurse who has additional hours and can come in and oversee infection control," Ms. Kirchner says.
2. Educate yourself, your staff and your physicians. There is no dearth of information on ASC quality control online, Ms. Kircher says. The problem lies with ASCs that fail to take advantage of it. Visit the ASC Quality website to read about the six measures developed by the National Quality Forum and download toolkits on hand hygiene, safe infection practices and point of care devices. Visit the website of your accreditation body of choice to learn about their standards and enroll in education programs — the Joint Commission and AAAHC both offer them. CMS also offers links to a variety of policies, regulations and manuals. Educating your staff is the most important thing you can do to be ready for stricter quality measures, and the information is readily available if you take the time to read it, she says.
3. Ask your nurses to use checklists during patient hand-off. One of the biggest mistakes ASCs make is failing to communicate with the patient's next provider, Ms. Kircher says. Several organizations, including AORN and the World Health Organization, provide guidelines to help nurses through the post-operative hand-off process. Unfortunately, you may find it hard to convince your nurses to use the checklist. "I still find that nurses don't want to do it," Ms. Kirchner says. "They think it's a waste of their time, and that's really getting into problems. They could miss an allergy or not see that the consent form isn't signed appropriately." Explain the importance of the hand-off process to your nurses, and if it doesn't sink in, require the use of checklists until the practice becomes second nature. Use AORN, the World Health Organization (pdf) and other resources to research proper hand-off procedures that you may have overlooked in the past.
4. Prepare for the move toward EMR. While hospitals rush to implement electronic medical records to track and measure quality data, surgery centers are, for the most part, falling behind. EMR implementation can significantly improve a facility's quality practices by alerting providers of potential errors and tracking quality data. Ms. Kirchner says ASCs will eventually be expected to use an EMR, and the industry is currently suffering from a shortage of IT-trained ambulatory nurses. To make sure your center isn't caught unprepared when ASCs begin the transition to EMR, research your options now. Some EMR vendors work specifically with ASCs, and the sooner you start looking at vendors and available IT staff in your area, the sooner you will be able to track quality without having to take the time to extract data manually.
1. Hire a full-time quality control nurse. As the requirements for quality control get stricter, it will become necessary to hire a full-time employee to oversee quality measures and ensure your center is up to par. Ms. Kirchner, who has worked with surgery centers since 1985, says she wouldn't have believed the need for a full-time infection control nurse five years ago — but times have changed. Going forward, nurses and administrators will find it difficult to juggle their regular responsibilities with the new responsibility of tracking quality data and comparing it against national benchmarks. ASCs should first look within the organization for a nurse who seems excited about improving the center's quality. "If you've got someone who's interested and wants to learn about quality, they'll become the owner pretty quickly," she says. "If you give the task to someone who has no interest, they'll never grasp it or do a good job." If no one at your center seems eager for the position, look outside the ASC for an external hire.
Smaller centers who can't afford another full-time employee can look for a hospital nurse consultant in the area. "If you have to meet regulations, look for a hospital nurse who has additional hours and can come in and oversee infection control," Ms. Kirchner says.
2. Educate yourself, your staff and your physicians. There is no dearth of information on ASC quality control online, Ms. Kircher says. The problem lies with ASCs that fail to take advantage of it. Visit the ASC Quality website to read about the six measures developed by the National Quality Forum and download toolkits on hand hygiene, safe infection practices and point of care devices. Visit the website of your accreditation body of choice to learn about their standards and enroll in education programs — the Joint Commission and AAAHC both offer them. CMS also offers links to a variety of policies, regulations and manuals. Educating your staff is the most important thing you can do to be ready for stricter quality measures, and the information is readily available if you take the time to read it, she says.
3. Ask your nurses to use checklists during patient hand-off. One of the biggest mistakes ASCs make is failing to communicate with the patient's next provider, Ms. Kircher says. Several organizations, including AORN and the World Health Organization, provide guidelines to help nurses through the post-operative hand-off process. Unfortunately, you may find it hard to convince your nurses to use the checklist. "I still find that nurses don't want to do it," Ms. Kirchner says. "They think it's a waste of their time, and that's really getting into problems. They could miss an allergy or not see that the consent form isn't signed appropriately." Explain the importance of the hand-off process to your nurses, and if it doesn't sink in, require the use of checklists until the practice becomes second nature. Use AORN, the World Health Organization (pdf) and other resources to research proper hand-off procedures that you may have overlooked in the past.
4. Prepare for the move toward EMR. While hospitals rush to implement electronic medical records to track and measure quality data, surgery centers are, for the most part, falling behind. EMR implementation can significantly improve a facility's quality practices by alerting providers of potential errors and tracking quality data. Ms. Kirchner says ASCs will eventually be expected to use an EMR, and the industry is currently suffering from a shortage of IT-trained ambulatory nurses. To make sure your center isn't caught unprepared when ASCs begin the transition to EMR, research your options now. Some EMR vendors work specifically with ASCs, and the sooner you start looking at vendors and available IT staff in your area, the sooner you will be able to track quality without having to take the time to extract data manually.
