Risk Tip: Ambulatory Surgery Centers

With greater pressure to reduce cost, growing dissatisfaction with hospital-run operating rooms, and just plain old convenience, it’s easy to see why Ambulatory Surgery Centers (ASC) and their use have exploded in the past 20 years. With their growing use is the growing misperception that ASCs are an ideal place for a greater number and more complex procedures because adverse outcomes rarely happen. Looking at the data, however, reveals that it is commonly not the procedure that causes problems, but the complication from the procedure.

Several factors should be considered when assessing the risks of outpatient surgery in an ASC. They include, but are not limited to, the health of the surgery candidate, the type of procedure, the facility’s capacity to handle emergencies, and the training of the medical personnel.

By recognizing and managing the potential risks associated with procedures performed in ASCs, physicians can minimize their liability and improve patient safety. Consider the following:

• Practice in an ASC that has been accredited, or encourage the ASC administration to seek accreditation.
• Assess the patient using established clinical criteria when determining his or her suitability for a procedure in an outpatient setting.
• Develop criteria for the length of surgeries and types of patients to be treated in an ASC.
• Develop a plan to deal with emergencies or crises, such as ACLS certification for staff and physicians.
• Be aware that bleeding is the most common complication and reason for subsequent hospital admission. Make sure patients receive specific instructions outlining what to do when bleeding occurs and how to evaluate the amount of bleeding.
• Provide patients and family with comprehensive discharge instructions that include a list of prescribed medications, diet and activity restrictions, and side effects related to surgery and anesthesia. Defining the time parameters related to surgical complications may help to ensure that the patient understands when to contact the physician.

Contributed by The Doctors Company. For more information the OSMA partnership with the Doctors Company, click here. For more risk management tips, articles, and information, please visit www.thedoctors.com/knowledgecenter.