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Performing procedures at an ASC? Be sure to assess your risk
e-Reports, June 1, 2010
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Q: What are the risks of associating with an ambulatory surgery center?

A: There are advantages of an ambulatory surgery center (ASC) for patients, such as no overnight stay and potentially less expensive procedures, but performing procedures at an ASC carries some inherent liability for physicians. This column is the first in a three-part series that will cover risks you should address if associated with an ambulatory surgery center.

According to the Ambulatory Surgery Center Association, over 8 million surgeries are performed annually in more than 4,000 centers nationwide. Each of those centers represents these areas of concern:

  • Medical staff and facility staff credentialing and competency
  • Patient screening and selection
  • Emergency response processes
  • Risk management/quality improvement/patient safety
  • Equipment and resources
  • Discharge planning

Medical staff and facility staff credentialing/competency process -
Physicians should ensure they and other health care providers at the ASC are appropriately credentialed and privileged to perform specific procedures. Policies should be in place to address the qualifications and scope of practice for surgical assistants and other allied health care providers.

Additionally, facility staff should be trained to respond to emergencies, such as initiating CPR, ACLS or PALS, and their competency should be assessed at least annually. It’s also a good idea to assess facility staff competency before using new equipment or performing new procedures.

Patient screening and selection process - Due to health care reform, the future patient population may include older, sicker patients and those with chronic conditions. Risk managers recommend patients undergo a comprehensive history and physical within 30 days of the scheduled procedure.

The ASC medical staff also should identify and document factors that may place a patient at an increased risk for hospital admission or death following the outpatient surgery. They include an age greater than 85, procedures lasting longer than one hour, the need for general anesthesia, obstructive sleep apnea or hyperreactive airway disease.

Our next column will address the emergency response process and risk management, quality improvement and patient safety concerns. Physicians insured by ProAssurance Indemnity Company, Inc. may contact our Risk Management department for prompt answers to liability questions by calling (800) 292-1036 or via e-mail.

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