If you manage an ambulatory surgery center (ASC), you know the benefits and the risks that come with performing outpatient surgical procedures. While ASCs have gained popularity as a convenient and cost-effective alternative to hospital admission, they have seen a gradual increase in medical professional liability claims.
 
Because ASCs usually stand alone, and are not typically located on a hospital campus, a lack of resources can contribute to catastrophic outcomes when something goes wrong. Although only 5 percent of Coverys’ claims in outpatient locations come from ASCs, 34 percent of those incidents resulted in permanent harm or death.
 
Is your organization prepared to identify and mitigate potential risks? Use the checklist below to assess your level of preparedness.
 

The 10-Point ASC Risk Management Best Practices Checklist


1. Ensure that a comprehensive patient evaluation is performed prior to surgery that includes:
  • Diagnostic testing to clear the patient for surgery
  • Anesthesia risk assessment
  • Comprehensive history and physical (conducted within 30 days of the scheduled surgery) to allow assessment of the patient’s readiness for surgery
  • A medical record with results of the history and physical present and visible prior to prepping the patient for surgery
  • A review of the history, physical and patient’s readiness for surgery, by the patient’s surgeon, upon the patient’s admission to the ASC
  • Consensus that there is nothing about the patient’s overall condition that would prohibit conducting the procedure in an ambulatory setting
2. Develop ASC policies that address the criteria used to determine which patients may be appropriate for services in the ASC. An example may be the use of the American Society of Anesthesia Physical Classification System score (ASA PS):
  • ASA PS I: Normal healthy patient
  • ASA PS II: Patient with mild systemic disease
  • ASA III: Patient with severe systemic disease
  • ASA IV: Patient with severe systemic disease that is a constant threat to life
An ASC that employs this classification system in its assessment of its patients may decide not to accept patients who are classified as ASA PS IV or higher. For many patients classified as ASA PS level III, an ASC may also not be an appropriate setting, depending upon the procedure and anesthesia.

3. Require an informed consent discussion to be conducted and documented by the surgeon performing the procedure. It should include but not be limited to:
  • Indications for the proposed procedure
  • Any alternatives available to treat the condition
  • The likely outcome(s) if the procedure is not performed
  • A review of the steps of the proposed procedure in lay terms
  • The risks and benefits of the procedure
  • The expectations for the recovery period, including how pain will be managed
  • When normal activities will most likely be resumed
  • Any expected residual effects from the surgery

4. Develop evidence-based protocols for the performance and management of all ASC procedures and provide staff education and training for pre-operative, intraoperative, and post-operative care.

5. Conduct a pre-procedure verification process involving the patient whenever possible, documenting:
  • Patient identification
  • Procedure to be performed
  • Surgical site, including laterality as appropriate to procedure
  • Identification of the items that must be available for the procedure
  • Presence of relevant documentation (e.g., diagnostic tests, history, and physical)
  • The need for any required blood or blood products

6. Mark the procedural site as follows:
  • The site must be clearly marked when there is more than one possible location for the procedure
  • If possible, involve the patient in the site marking process
  • The site is marked by the provider who is accountable for the procedure
  • The site marking is visible after skin preparation and draping

7. Ensure emergency equipment and medications are available to treat known possible complications of all procedures performed:
  • Provide training to staff members in the use of emergency equipment and medications
  • Establish a schedule to properly maintain emergency equipment and monitor emergency medications for expiration and replacement
8. As a routine, contact all ASC patients within 24 hours of discharge to determine their status and stability.

9. Collect patient satisfaction data and review results regularly to improve performance.

10. Report all complications and medical errors, track and trend occurrence data, and develop action plans to respond to any identified trends.

Next Steps

Of course, ASC risk management is not a one and done exercise. To successfully mitigate claims over the long term, you need on an ongoing process for identifying risks, educating your team, implementing procedures, and monitoring results. Coverys can help. To learn more about how our proven risk management model can help you, please contact us.


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No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only. These informational materials are not intended and must not be taken as legal or medical advice on any particular set of facts or circumstances.