Vol. 2, No. 1
ASC PHYSICIAN FOCUS Add More Complex Procedures
AN ASCA PUBLICATION >> Contents
• Safely Moving Cardiology Procedures to ASCs ..........................2
• Purchase ASCA’s Webinar All- Access Pass ...........................................2
• Improving Your Governing Board’s Effectiveness .......................................3
• Study: ASCs an Appropriate Site for Spine Surgery ...............................3
• Embracing the Self-Funded Model of Health Care .....................................4
• Study: Fewer Post-Surgery Adverse Events in ASCs vs. HOPDs ................4
Message from the CEO
health care, there are some who continue to question the level of quality and safety ASCs provide.
The studies mentioned here and others show otherwise. Nevertheless, the need to validate the quality of care ASCs provide remains.
To that end, we encourage ASCs to collect data, analyze that data, share that data, participate in registries like the American Joint Replacement Registry and do whatever they can to continue positioning ASCs as the optimal site for outpatient surgical care.
Anyone with important findings that they are willing to share with the ASC community should contact Alex Taira, ASCA policy analyst, at ataira@ascassociation. org.
Bill Prentice Chief Executive Officer
This issue covers innovation in many areas. As we continue to look at innovative ways to advance
Four ASC leaders share considerations and guidance for bringing more complex procedures into ASCs.
Anthony Asher, MD, Neurosurgeon and Senior Partner at Carolina Neurosurgery & Spine Associates in Charlotte, North Carolina, and ASCA Board Member: We make preliminary determinations of procedures that might be suitable for migration to outpatient settings based on the potential for care standardization, cost reduction and achievement of equivalent or advanced outcomes. We subsequently perform an inpatient validation of the techniques we propose to migrate to outpatient environments through objective analyses of safety, technical feasibility, pain control and clinical effectiveness. Finally, once we have defined “appropriate” patient cohorts and case types based on these inpatient observations, we use quality science methods—particularly prospective registries and other clinical data tools— to continuously assess and promote quality, safety and effectiveness while patients are being cared for in ASCs.
Matt Bush, MD, Orthopedic Surgeon at Central Maine Orthopaedics (CMO) in Auburn, Maine: Before I performed my first total shoulder replacement at CMO, we performed two mock surgeries a few weeks apart. A team composed of myself, circulating nurses, technicians, a physician’s assistant, an anesthesiologist and an implant company rep came together. A member of the staff pretended to be the patient. We then did a complete walkthrough of the surgical experience, from admitting through discharge. It was a very live process covering everything from patient and equipment positioning to cement preparation. We wanted to ensure staff was prepared and ready to perform this new procedure. That went a huge way with our crew. Everybody had an opportunity to ask questions. The mock surgeries created a more easily reproducible experience. When the day came for our first real total shoulder patient, everyone was
comfortable and fired up. It was one of the easiest cases I’ve ever performed.
Michael Patterson, President and Chief Executive Officer of Mississippi Valley Health in Davenport, Iowa, and ASCA Board Member: Complex procedures can be transitioned safely and effectively to the ASC setting if there is appropriate planning and training. First, ensure your patient selection policy is updated to include specific screening tools for more complex procedures. Those should be discussed at the medical executive committee level and have input from the surgeons and anesthesia providers. Discharge planning and education should occur at the time of scheduling. Ensure patients and their families understand what will be expected of them when they leave the ASC. Develop clear clinical pathways and protocols for patients undergoing complex procedures, and review and update those protocols on a routine basis. Make improvements as your program develops. Finally, always prepare for emergencies. This should occur whether you are doing complex or routine procedures.
Andrea Slavik, RN, Joint Care Coordinator for the Total Joint Center of St. Louis in Creve Coeur, Missouri: For our ASC to continue its success, joint patients must receive preoperative education. Our preop class helps put patients at ease, eventually leading to better outcomes. Patients receive a total joint guidebook at their surgeon’s office. They are encouraged to read it and perform the included preop exercises. When we review everything in the class, all the information seems to click and make sense. Patients and their caregivers develop confidence since they know what to expect on the day of surgery and during the recovery period at home. Patients also learn about complications to report and pain management. This process decreases anxiety about the surgery day, better preparing them for their procedure and supporting a more comfortable and safe recovery with better outcomes.
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