We've had a few mishaps with our lab specimens, including that time we were certain that we'd sent a breast biopsy to the lab, only to hear back that the jar was empty. (The patient had to undergo a second biopsy.) To help ensure that a specimen makes it into the container, an OR tech and a nurse now write "visualized by" and their initials on the pathology requisition slip (see inset). This confirms that two people have seen the specimen. Nurses also call the lab on a regular basis to make sure suspected malignancy reports have gone out to the physicians' offices.

Susan Dievendorf, RN
Nursing Director
San Antonio ASC
Upland, Calif.
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Catching Up With Your Doctors' Signatures
Keep laminated folders, labeled with the name of each surgeon and anesthesiologist working at your center, behind the scheduling desk. When you receive operative reports, incomplete charts, infection reports or communication bulletins that require a doctor's attention, file them in the appropriate folders for signatures. Place each doctor's folder in the dictation area on the day he has cases scheduled. Then each doctor knows he's to complete his "homework" when he sees the folders out. This is a good way to get all your paperwork reviewed, signed and filed in a timely fashion.

Deborah D. Comerford, BSN, CNOR
Director of Clinical Services
Facility Development and Management, LLC
Orangeburg, N.Y.
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Wouldn't It Be Nice to Give Patient Escorts Those Vibrating, Flashing Pagers?
A common complaint of the families of patients undergoing surgery is that they're confined to the waiting room while their loved one is in the operating room. Rather than grabbing a bite to eat or drink or using their cell phones outside, they remain seated for fear that they'll miss the opportunity to speak with the surgeon or a chance to see the patient. Our solution was to provide them with lighted and vibrating pagers, similar to the ones you get while waiting for a table at a restaurant. This lets us alert family members that they're needed at the main desk and provides freedom from the waiting room for patients' loved ones.

We started out with 16. We're now up to 40. To give you an idea of cost, the master transmitter was $1,199; each pager was $69; and a 40-pager charging rack was $399. Total cost: Less than $4,500. The manufacturer we selected set up the paging system and trained our staff on how to use it (it's very simple; each pager has its own telephone number, although no phone line is needed) in just a few hours.

Debbie Runyan, RN, BSN, MS
Director, Surgical and Anesthesia Services
Froedtert Hospital
Milwaukee, Wis.
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An Easy Way to Make Sense of the Alphabet Soup
Each month our CEO and I have lunch with a small group of managers to learn more about what's going in their departments and to find out what's on employees' minds. At a recent meeting, I asked a new manager about her orientation to the organization. She said it had been going well, but that there were many acronyms and historical items that she simply couldn't put into context. We realized she wasn't alone, and so we decided to create a site on the hospital intranet explaining the acronyms and their origins. A few examples:

• JCAHO - Joint Commission on Accreditation of Healthcare Organizations
• CAM - Center for Ambulatory Medicine
• FON - Friends of Nursing
• NICU - Neonatal Intensive Care Unit
• SMC - Senior Management Council

All employees have to do to find out what something means is click the "What Does that Mean?" icon on our hospital intranet, go to a letter prompt (for instance, "J" if they want to know what JCAHO means) and click on the acronym they're looking for. The page that then comes up includes the full phrase and a brief explanation. Employees can also search simply by typing the acronym into a search box. We've gathered more than 350 acronyms.

Lou Liebhaber, COO
Lehigh Valley Hospital
Allentown, Pa.
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Making Room for Pain Docs in an ASC
Unlike most other docs, pain docs may try to provide patient care without fixed office space. They're used to traveling to a surgery center or a hospital to do a procedure, but they can't do their consults, evaluations and medication management in the surgery center. CMS doesn't approve of any non-surgical services taking place at a surgery center. the State Operations Manual, Conditions for Coverage state that an ASC must be exclusive to the provision of surgical services.

To accommodate the regulation, I tell docs who are thinking of starting an ASC to do this: Create two distinct entities, separated by a firewall. One would be the pain doc's office. The other would be the ASC. There could be a vestibule between the two perhaps, but in most states these would have to be separate entities with different tax ID numbers and separate waiting rooms.

In this case, the exam in the doc's office would be billed as place of service non-facility (office 11), and the pain procedure would be billed as place of service facility (ASC 24 or hospital outpatient department 22). A pain doc who examined a patient at an ASC and decided a pain procedure was necessary right away at the ASC couldn't bill for the examination and the procedure separately. And he's technically jeopardizing the ASC license and Medicare certification by doing both the procedure and the exam at the ASC.

What will work: Examine a patient in the office, discharge him from the practice and admit him to the ASC. Then perform the pain procedure there.

Amy Gail Mowles
Mowles Medical Practice Management
Edgewater, Md.
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