Risk Management for ASCs
Advances in technology and anesthesia now allow invasive procedures once done only in hospitals to be performed in ambulatory surgery centers. This trend is evident in numerous specialties: otolaryngology, ophthalmology, gynecology, dermatology, general surgery, gastroenterology, oral surgery, and plastic surgery, among others.
All operative or invasive procedures, particularly those which use sedation or anesthetic agents, carry inherent risk. Ambulatory surgery centers (ASCs) must have measures in place to identify risks and develop strategies to prevent and mitigate harm from these risks.Patient selection is a shared responsibility of the ambulatory center and the physicians who practice there. The ASC should develop general rules and guidelines to ensure that there is uniformity of decision making with regard to patient selection and to ensure that poor candidates for ambulatory surgery are identified.
One of the most important issues for risk managers at ASCs to consider is patient and family expectations for ambulatory surgery. Most malpractice suits are brought because patients become angry. In some cases, patients’ anger stems from unrealistic expectations of the outcome of treatment. For this reason, it is important that physicians adequately inform their patients about the nature, risks, and alternatives to ambulatory surgery.
The first line of defense against unrealistic patient expectations is the informed consent process. The patient must be fully informed about what he or she can expect in the way of results — as well as side effects — from the surgical procedure.
Facilities also can be held liable for injuries that result from improper discharge; thus, it is critical to establish and adhere to policies that limit the risk of injury. Patients should be discharged using medical staff-approved criteria; rigorous compliance with the criteria must be fully documented in the patient’s medical record.
Additional policies and procedures should be established in other areas to minimize risk. These areas include the following: medical recordkeeping and documentation, patient confidentiality, medication safety, infection control, medical technology management, handling and safeguarding of patient valuables, postoperative transportation, and a plan for the transfer of a patient to an appropriate hospital when hospitalization is indicated.
These tips were provided by ECRI, a Plymouth Meeting, Pa.-based not-for-profit organization providing risk management and patient safety resources to healthcare facilities.