At the 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + the Future of Spine, June 12 in Chicago, Carol Hiatt, BSN, RN, LHRM, CASC, CNOR, an independent consultant with Healthcare Consultants International, discussed risk management strategies for ambulatory surgery centers performing innovative spine procedures.
There are several risks inherent in performing spine surgery in the outpatient setting as it is a rapidly evolving field with new changes and technology emerging quickly. Here are five strategies to help manage risk when performing spine surgery in an ASC:
1. Select candidates for surgery carefully. ASCs need to have patient selection criteria in place for spine surgery and they need to stick to the criteria, said Ms. Hiatt. It is important for physicians to know what the patient's co-morbidity history is and other factors that may affect clinical outcomes. "ASCs should consider putting a policy in place requiring clearance from an internist for all patients who meet certain thresholds," she said. "Facilities need to be rigorous about the patient selection criteria."
2. Follow a predetermined process. ASCs need to plan out the process by which new procedures will be introduced into the center. Ideally, the first step should be the formation of a leadership team. "You need physician buy-in and you also need the administration team to get behind it," said Ms. Hiatt. "Your staff will feel more secure if all the appropriate steps have been taken and team ownership and buy-in is established before a new procedure is brought in."
3. Ensure training and credentialing. Identify staff and surgeon training and budgetary needs and make sure those needs are met, said Ms. Hiatt. If possible, the surgery center's team should try and visit a facility where the new procedure is being performed. "Another vulnerable area is surgeon credentialing for the new procedure," she said. "Ensure that your physicians show you that they are appropriately credentialed to perform the new procedure. Don't forgo this step."
4. Ensure the competence loop is complete. When starting to perform new procedures, make sure here are enough staff members competent in performing various aspects of the procedure so they can back each other up to ensure a great outcome, said Ms. Hiatt.
5. Track complication rates. Once a surgery center has started performing the new procedure, it is important to track complication rates unique to the particular device or procedure as well as the unique patient population involved. "Track your rates and compare them with published rates so you can compare your center's performance," said Ms. Hiatt.
"Eliminating risk is impossible, but identifying and managing risk is imperative," said Ms. Hiatt.
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