turnover time, improving reimburse- ment, reducing infection or enhancing patient satisfaction scores.”


A well-balanced center should


include business office topics as well, Mattson says. “This area can be eas- ily overlooked but is an area that also needs attention.”


Making Smart Selections


QAPI topics can be hard to pick, Kirchner says. “One of the approaches I take is to look at audits performed on an ongoing basis, such as risk and variance reports. I am not only look- ing for something that actually hap- pened to a patient or staff member. It could be a near-miss, something that, if it was not caught, may have resulted in harm.” Schneeweiss-Keene says one topic that became an important QAPI proj- ect for her ASC concerned random instances of toxic anterior segment syndrome (TASS), which causes acute severe intraocular inflammation. The project required extensive work, she says, with the center exploring numer- ous possible changes, including not using enzymatic solution, switching enzymatic solution, changing devices and running a variety of tests. “We finally concluded that the cause of the TASS was the way we were rinsing our instruments after submerging them in our enzymatic bath in the ultrasound,” she says. “We were performing an initial rinse with tap water and then a final rinse with distilled water, which was not doing the job. After we switched to only using distilled water, our TASS cases stopped. The QAPI team and our doctors were relieved to finally find the solution.”


Mattson recommends closely


reviewing patient satisfaction sur- vey results. “You are looking for any insightful comments as well as any scores that are lower than what you feel is ideal to determine what your patients perceive as areas in need of


Some QAPI topics to consider are those that might improve patient care and keep patients safer or improve the process flow for your team, which will then free up staff members to become even more effective in their roles.”


—Beverly Kirchner, RN, CASC, SurgeryDirect


improvement. In addition, include your staff and physicians in the iden- tification of areas that they perceive as requiring improvement.” Kirchner adds, “I have found


that physicians are one of the best resources for ideas on performance improvement because they have no shyness when you ask what you can improve for them. They can probably give you a long list, if prompted.” Another potential source for QAPI project ideas, says Kirchner, is regu- latory issues. “What is being talked


about in the industry and your spe- cialties? What are experts viewing as important issues and do those reso- nate with your team? Just be care- ful not to jump on an issue because it is trendy. You need to select what you feel is truly a potential danger or challenge for your center.” As you narrow down your choices,


avoid gravitating toward topics that are likely to lend themselves to eas- ier projects, Kirchner says. “An easy project can yield worthwhile results, but the simplicity factor should


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