Posts Tagged ambulatory surgery center
Patient’s who have minor surgery at an ambulatory surgery center (ASC) don’t really know what to expect. And, after the experience they often wonder whether they received high quality care. The basis for thinking the quality was good is usually the perception the staff was friendly and the fact the patient indeed survived to ride home in a car with a friend or relative.
There are more than just those 2 dimensions of quality. What should an informed consumer watch for? Or, more likely, what should family members who accompany the patient look for? After all, the patient is a little anxious before surgery and often sleepy after surgery, mostly concerned about getting to the car.
Here is how a smooth high quality ASO interaction works:
- Primary care physician contacts the surgeon about the patient by phone or secure email to see what steps need to be taken for a possible outpatient surgery — like treatment of carpal tunnel syndrome. And, the surgeon gets information about the patient’s other health problems. Appropriate tests are ordered and an appointment with the surgeon is made within about a week. All records are electronic and made available to the surgeon.
- The surgeon has a clinic visit with the patient. The nature of the surgery is explained to the patient both verbally and with diagrams. The surgeon states whether they feel the proposed surgery is reasonable under the circumstances and describes what the surgery entails from their standpoint. But, no decision is made by the patient at that point. The surgeon uses a shared decision making technique. Meaning, the patient is given literature and internet links to review. Also, a link to all previous patient satisfaction surveys about the same surgery are provided to the patient. Plus, a packet with all the documents that must be signed. Staff review the patient’s insurance and estimate for the patient ALL the out of pocket costs of the surgery (surgeons fees, ASC fees, devices, and drugs).
- Later, perhaps a couple of days later, the surgeon calls the patient, questions are answered and a joint decision is made about whether to proceed with the surgery. Also, at some later time the patient talks to the anesthesiologist on the phone and can ask questions about anesthesia issues.
- If the patient wishes to proceed the necessary documents are signed (on paper or electronically) and an appointment for surgery is made. The patient takes or sends the documents, including operative consent, HIPPA forms, etc, to the doctors office. The primary care records, the surgeons records and the documents are made available to the ASC. No additional forms need to be signed or completed at the ASC.
- If there are questions about medication management or other medical issues another phone call or email is exchanged with the primary care provider. The patient should never be a messenger asked to get information or ask questions about medications from the primary care provider.
- Required pre-operative examinations are performed by the surgeon or assigned physician assistants in a timely manner.
- The patient arrives at the ASC at the appointed time, no additional paperwork is needed.
- The patient is taken to a personal pre-operative room, not to a public waiting area — privacy of outpatient surgery is important. All patient charting is done with a computerized system.
- The nurses, anesthesiologist and surgeon meet with the patient and family. Any last minute questions are answered and post-operative instructions are discussed with the patient and persons taking the patient home.
- After appropriate preparation the patient is taken to the operating room and after surgery returned to a recovery room, hopefully the same room they started in. The surgeon and anesthesiologist meet with the patient and persons taking the patient home to relate the outcome of the surgery and to repeat the post-operative instructions. Written instructions with a follow up appointment date and time are given to the patient. A phone number answered 24 hours per day is given to the patient for any problems or questions that arise at home. Telling the patient to go to the ER for all problems is not acceptable.
- No patient should feel they are the last patient of the day and must leave because the ASC is closing. The ASC must stay open for several hours to accommodate all needs of that last patient of the day. Minor complications, like urinary retention, should be resolved by the ASC, not an ambulance transfer to the ER.
- The surgeon sends the operative report electronically to the primary care provider and sends a letter to the patient about the diagnosis and results of surgery.
- Later in the day or the following morning someone at the surgeons office contacts the patient to see how they are getting along, to answer questions and prescribe additional medications or treatments if needed. The date and time of the follow-up appointment are again reviewed. The patient is asked to participate in a patient satisfaction survey.
- The patient fills out the satisfaction survey on paper or on-line.
- The patient returns for the post-op visit with the surgeon as scheduled. The final diagnosis is discussed with the patient and further instructions are provided.
Well, is that how your outpatient surgery went? If yes or if no, leave a comment. What was good at your ASC and what was bad?
Ambulatory Surgery Centers (ASC) are adept at hiding problems. Just try to find death rates, numbers of transfers to hospitals, organ punctures, and surgical procedures required to correct errors. Nope — you won’t find those crucial bits of data for public view. Here is a link to statistics collected for “internal” review: Quality Reporting Program.
As with most health care entities the public expression of “quality” is “certification” — which means an outside reviewer thinks the organization has the right programs and procedures so nothing stands in the way of quality care. Likewise, nothing usually stands in the way of a student getting an A+ on a test — but A+ is not always the grade. As Confucius says: “there are always greater and lesser”.
So, as a patient, what should you look for; what questions should you ask?
- Is the ASC certified? If not, find another ASC.
- How many patients does the surgeon treat at the ASC — expect at least 10 per week.
- How often does the surgeon do the procedure you need at the ASC — expect at least 10 per month.
- Will you be sedated? — if so, make sure an anesthesiologist or nurse anesthetist will be monitoring you while sedated — if not — find a different ASC.
- How close is a hospital if you have one of those serious complications listed in the consent-for-surgery form? If an ambulance would take more than 10 minutes to get you to the hospital consider another ASC.
- If you have severe heart or lung problems (like a history of congestive heart failure or COPD) consider having your procedure at a hospital rather than at an ASC.
- Ask if a pre-op check list, like the one the World Health Organization recommends, is used for all surgeries — if not, quality is a questionable. If the surgeons says they don’t need a check list find a different surgeon. Keep this in perspective — every airplane pilot must follow a pre-flight checklist, is your surgery any less important?
- The person that comes with you needs to write down what the surgeons says after the procedure. Patients who have been sedated, even if they seem fully awake, will have impaired memory for many hours. Have the person with you write down what was found at surgery — what is the diagnosis and what are the specific instructions.
- Absolutely avoid late afternoon surgery — because you will be shipped to the hospital for minor complications — the ASC will close and they don’t have staff to provide care after closing.