COVER STORY
Like the other ASCs that offer over- night care, Gross will make arrange- ments with local restaurants to deliver food for the patients. He will not, how- ever, let families stay at night. “We are not a hotel; we don’t have the services or security needed to care for families overnight,” he says. For security, he will use key cards as his ASC does now. “We might need to get a lab involved, to do blood counts, etc.,” he says. “We will work with local labs and have them come in in the morning to take blood, if necessary. Luckily, we have physical therapy (PT) in the building. You have to make sure that the patient has mobil- ity prior to sending them home. “Other than that, keep the patients
comfortable, give them iPads, roll in a TV set, offer connectivity, and you are good to go,” Gross says.
Colorado
Colorado allows for a separately licensed CC, with the same ownership group and administrative staff, located in the same building but separated by a firewall, says Rebecca Craig, RN, CASC, vice president of ASCA’s Board of Directors and chief executive offi- cer of Harmony Surgery Center LLC and Peak Surgical Management LLC in Fort Collins, Colorado. She operates a separately licensed CC for her patients who need extended recovery care. “The CC has six private rooms and houses on average one to two patients per night,” she says. “We admit Monday through Thursday, and only allow CC admis- sions from patients who have had a sur- gery or procedure in our ASC.” Typi- cally, the center has 13–15 patients out of its 300 surgery patients a month who need to stay overnight, and it closes the CC if it does not have any patients who need extended recovery care. “Patients are wheeled on a gurney
from the ASC to the CC through a set of doors that separate the two facilities, and while our total joint patients stay for two nights, most of our patients, typi-
12 ASC FOCUS SEPTEMBER 2015
My advice to other states would be to work hard to develop those strong relationships with their state regulatory agencies and their law makers. CASCA has done a tremendous job to help facilitate those conversations and relationships.”
—Rebecca Craig, RN, CASC Harmony Surgery Center LLC and Peak Surgical Management LLC
cally, stay for one night,” she says. “To patients it appears seamless, and 90 per- cent of our patients know before their surgery if their surgeon wants them to stay overnight. Pain and nausea manage- ment are the two most common reasons for unplanned admission to the CC.” The ASC and the CC both require
transfer agreements to be in place with the local hospital, Craig says. “During our 15 years of operating the CC, we have had an excellent track record with high quality outcomes and minimal transfers to the local hospital,” she says. The emergency management prac- tices at the CC mirror the local hospi- tal’s in terms of equipment and staff training, she says. The CC has equip- ment such as crash carts, automated external defibrillators (AED), chest tubes and a tracheotomy set and equip- ment for airway maintenance; and offers training, including ACLS and
pediatric advanced life support (PALS) certifications for all RNs. “Staff- ing at the CC depends on the acuity of the patients,” she says. “Our regu- lar staffing plan consists of one RN and one nursing assistant. We rarely fill all six rooms and usually have one to two patients stay overnight. If we have patients with higher acuity, we consider staffing with two RNs. The admitting surgeons or group partners and anesthesiologists are on call dur- ing a patients’ stay.”
Craig contracts for services such as food/nutrition and physical ther- apy and has a pharmacy consultant. “We have food catered based on the patient’s preferences and surgeon’s dietary orders,” she says. “If labs are needed in the middle of the night, clin- ical leaders run them to the hospital. We have two local hospitals and trans- fer agreements with both.” Last year, the Colorado Depart-
ment of Public Health and Environment (CDPHE) worked with the Colorado Ambulatory Surgery Center Asso- ciation (CASCA) to combine the CC licensure with the ASC licensure. “Our state department has been very progres- sive and helpful,” she says. “We have worked hard to have a good relation- ship and partner with them. My advice to other states would be to work hard to develop those strong relationships with their state regulatory agencies and their law makers. CASCA has done a tremendous job to help facilitate those conversations and relationships.” Insurance carriers have been very
responsive because they see the finan- cial savings coupled with the high qual- ity outcomes—“it’s a win-win,” she says. “Carriers understand that patients are shopping around looking for high- quality, cost-effective alternatives and our ASC and CC are able to meet that need. Just to give perspective on the financial savings, typically, a night in the CC would cost a third of what it would cost at a hospital.”
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