OR Manager April 2022 - 30
AMBULATORY
SURGERY CENTERS
BY JENNIFER LUBELL
A systemic approach to cardiac service line safety
Seek guidance from the experts.
Among Surgical Care Affiliates'
(SCA)
260-plus facilities in the US, at least
10% have added cardiovascular/peripheral
vascular service capabilities. SCA
experts anticipate more growth in this
area. However, any successful launch
starts with an organizational focus on
patient safety, says Ezra Erb, vice president
for clinical quality at SCA, which
is based in Deerfield, Illinois, and in
Birmingham, Alabama, and serves 1
million patients annually. " Safety integrates
with our overall patient program.
This includes our single and multispecialty
facilities that are starting to
perform cardiac procedures with other
lines, " says Erb.
Erb joined Kami Dinkel, SCA's director
of operations, and Marty Taglauer,
director of clinical quality, CV programs,
to discuss the following safety basics in
ASC cardiovascular (CV) service lines.
Take the time to plan and do not skip
or undercut the planning process, says
Erb. " Sit down with the physicians involved
and think things through. Ask: are
we prepared for specific procedures? Is
this sustainable? Do we have the right
equipment, the right training, the right
team in place? " Take the time to fully
assess things with your team before you
roll out a new service line. Identify your
patient criteria and gauge the community
need for a cardiac service line.
Start with less complex procedures,
like cardiac rhythm management as opposed
to more advanced cardiac catheterization,
which has more capital requirements
and complex safety procedures.
The planning stage is also the
time to assess your staff and see which
members of your team have CV experience.
" Some hiring may need to be
done, " Taglauer says.
Conduct ongoing training sessions
once that team is established, adds
Taglauer. " Perform annual competencies
and drills to make sure the team is
prepared to handle anything that comes
their way. "
30
OR Manager | April 2022
The Agency for Healthcare Research
and Quality's survey of patient safety
culture measures the full spectrum of
individuals involved in patient care and
their feelings of confidence in safety
preparation. SCA uses this metric to survey
its clinicians and support staff, and
most importantly, its anesthesiologists
and surgeons " so that we really have a
360-degree perspective of everyone who
is touching the patient, " says Erb.
National governing societies for cardiac,
vascular, and interventional radiology
have released their own safety
recommendations for outpatient cardiac
procedures, says Dinkel. " This includes
facility structure, emergency planning,
equipment, staffing, and processes you
should have at the basic level. They
also provide guidance on patient selection
for cardiac patients. "
Allowed procedures vary by state
and are regulated by the department of
health. " It's important to look at local
regulations on cardiac procedures, "
says Taglauer.
Choose the right patients. SCA has
general selection criteria, " but we also
do this on an individual basis, " says
Dinkel. " Clinicians review everyone's patient
information and make sure admission
criteria are met. We look at what's
different for each patient and take that
into consideration for each patient. "
Physicians should use the American
Society of Anesthesiologists' Physical
Status Classification System score to
assess who is safe for surgery and who
is not. " We look at history. Has the
patient had multiple percutaneous coronary
interventions, electrical events,
ventricular tachycardia? " asks Dinkel.
Is the patient at high risk of an adverse
reaction or complication? Patients with
kidney issues or those with a recent
myocardial infarction might be better
served in the hospital, which has dialysis
machines and more advanced emergency
equipment.
Prepare for emergencies. In the OR,
ASCs can prepare for emergencies by
having safety and back up equipment
such as balloon pumps, temporary
pacemakers, and a crash cart.
Make sure your X-ray system and OR
table are relevant for procedures, he
adds. Ensure a transfer agreement with
a nearby hospital with the right capabilities
is in place " so that if needed, you
can get that patient to a proper level
of care as quickly as possible, " says
Taglauer.
Have a discharge plan. Think about
what happens after the patient has left
the facility, urges Taglauer. " Make sure
you're looking at the chart review and
at outcomes. Look at the program as a
whole and see that you're taking care of
everything, from infection to complication
rates. "
At SCA affiliated facilities, an important
consideration with vascular procedures
is the access site, says Dinkel.
" If you're going into an artery or vein,
you want to make sure it is stable postprocedure,
and educate the patient and
family on what to do and not to do to
avoid infection. "
Any ASC looking to add CV procedures
should do research on quality
assurance to capture accurate outcome
data, says Dinkel.
Training your staff is important, Erb
says. " A manager should be able to
assess: does the culture of my facility
support clear communication? " Staff
should be able to respond and react
quickly and collaboratively as a team
to support every patient that enters the
facility. ORM
Resources
ASA Physical Status Classification
System. American Society of Anesthesiologists.
Last amended on
December 13, 2020.
SOPS Surveys. Agency for Healthcare
Research and Quality. Accessed
February 2022.
www.ormanager.com
https://www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system
https://www.ahrq.gov/sops/surveys/index.html
http://www.ormanager.com
OR Manager April 2022
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