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COVER STORY


Develop protocols to guide decisions BY ROBERT KURTZ Which Patients Can Undergo Your Higher


Acuity Procedures? T


he Ambulatory Surgical Center of Stevens Point in Stevens Point,


Wisconsin, started performing total joint replacements in 2010. Since the program's launch, only a few patients have required postoperative transfer to a hospital. This, says Thomas Wen- man, a certified registered nurse anes- thetist at the ASC, is a testament to the center's commitment to careful patient selection for the higher acuity cases. “It is a bit of a job to more closely screen these patients to make sure they are not going to need ventila- tion, a transfusion or have some other urgent postoperative need,” says Wenman, who is also the president of Stevens Point Anesthesia in Ste- vens Point, Wisconsin. “But when the goal is to identify the most appropri- ate patients for these procedures and hopefully avoid transfers as much as possible, that extra work is essential.”


12 ASC FOCUS MAY 2021 | ascfocus.org


Cumberland Valley Surgery Center in Hagerstown, Maryland, has devel- oped what Administrator Amy Sachs, RN, describes as “red-light criteria,” which could exclude a patient from the ASC’s total joint program. The multi- system criteria include a range of car- diac conditions, moderate to severe chronic obstructive pulmonary dis- ease (COPD), body mass index (BMI) above 40, poorly controlled diabetes, some neurology conditions, chronic pain management requiring daily opi- ates and history of deep vein thrombo- sis and pulmonary embolism. The criteria are reviewed by the performing physician and scheduler prior to scheduling the patient. Once the patient is scheduled, the total joint team’s nurse navigator reviews the patient’s chart to verify that the patient meets the guidelines. If a patient does not meet all the crite-


ria, the nurse navigator discusses the case with the physician and an anes- thesia provider. The patient is either excluded from the program or steps are taken to optimize the patient prior to surgery.


“Based on current research and


personal experiences, we know that patients who follow these guidelines do well in the outpatient setting,” Sachs says. “When these guidelines are not followed, patients are more prone to postoperative complications or possibly a hospital admission.” At The Surgery Center of Fair- banks in Fairbanks, Alaska, David Flory, MD, the ASC’s medical and anesthesia director, looks for a vari- ety of indicators to help determine whether a patient should undergo one of the higher acuity procedures of the ASC, such as a total joint replacement or cervical fusion. “A patient with a history of bad lung


disease and significant cardiac disease is not likely to be a viable candidate for surgery here,” Flory says. “Then


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