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Part II: Performing procedures at an ASC? Be sure to assess your risk
e-Reports, July 26, 2010
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Q: What are the risks of associating with an ambulatory surgery center?

A: The first step in effectively handling crisis situations is having emergency response procedures in place. Procedures should detail the responsibility of the center and its staff to respond to an emergency, as well as timely transfer of patients to a hospital. For example, a fully stocked emergency crash cart is only as effective as the skills of the people using it. Are staff members properly trained? Is the equipment periodically checked to ensure accessibility and functionality?

Additionally, procedures should identify basic requirements for handling emergencies:

  • Be sure staff members understand their individual responsibilities during an emergency – e.g., who will provide basic life support, which staff member will arrange transport to a hospital, etc.
  • Paste emergency numbers by telephones and at the nurses’ stations. It’s recommended that all clinical staff have BLS training; periodic re-certification is required.

In minor emergencies, patients may refuse transport by ambulance to a hospital or emergency department, or they may refuse to go to the ED at all. In such cases, risk management experts recommend physicians explain the seriousness of the patient’s condition and associated risks of not following medical advice.

Patient safety, quality and risk
Here are patient safety and risk management questions you may want to ask before performing procedures at or referring patients to an ASC:

  • Is the facility licensed/accredited by the state, the JCAHO, etc.?
  • Does the facility routinely track patient complications and admissions to an acute care facility within 72 hours post procedure?
  • Does the facility support a culture of safety in which staff are encouraged to speak up, voice concerns, report “near misses,” etc., without fear of retribution?
  • Does the facility have an incident reporting process?
  • Does the facility regularly conduct patient satisfaction surveys?
  • Is there a formal infection control program?

If you answered no to any of these questions, you may want to contact ProAssurance’s Risk Management department for assistance. Read Part I of this series on the ISMA website.

Our next column will address equipment, resources and discharge planning. 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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