A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Zzz Zzz
Published: 10/10/2007
Predicting Which Patients Will Be Hospitalized
New Patient Index Measures Risk Factors for Post-op Admission
Who are the most likely surgical outpatients to wind up being hospitalized immediately after an operation? Those who are 65 or older, receiving general or regional anesthesia, and undergoing procedures longer than two hours, according to a checklist of risk factors created by researchers at the Univer-sity of Pennsylvania School of Medicine.
The index, published in the March issue of Archives of Surgery, is based on a review of 783,558 same-day surgery patients, 95 percent of whom underwent surgery in a hospital-based facility. Of that group, 4,351 were admitted to a hospital following surgery and 19 died, equating to one death per about 50,000 patients, according to the report. The researchers excluded cardiac catheterizations, endoscopies and cataract operations.
Based on these findings, the researchers developed a summary score to identify patients at elevated risk for post-op hospitalization, assigning one point each for patients being 65 years or older; having an operating time longer than 120 minutes; cardiac diagnoses; peripheral vascular disease; cerebrovascular disease; malignancy; HIV-positive status; and regional anesthesia. Due to increased risk factors, patients receiving general anesthesia were assigned two points. Patients with an index score of three have 21 times the odds for hospital admission than patients receiving a score of zero or one. Patients with scores of four, five and six, meanwhile, have 32 times the odds of admission.
Lead author Lee A. Fleisher, MD, FACC, FAHA, chair of Anesthesia and Critical Care for the University of Pennsylvania Health System, notes that the research focused on procedures performed at hospital outpatient settings and may not reflect findings from freestanding facilities. There was no data on the patients' presurgical situation or whether some of the admissions were planned. He does believe, however, that the system can be used for enhanced patient safety and high-quality care.
"As outpatient facilities continue to push the envelope, we need to take steps to match the location of care with the risk factors of patients," says Dr. Fleisher.
- Daniel Cook
The Effects of Horizontal Violence
Study: Nurses Who Are Bullied Likely to Suffer PTSD and Endanger Patients
Nurses who are bullied by their fellow nurses and surgeons are more likely to suffer post-traumatic stress disorder, switch jobs and make errors that compromise patient safety than nurses who aren't bullied, according to an online survey of nearly 1,100 perioperative RNs.
"Horizontal violence must be stopped in the healthcare workplace by developing and enforcing a no-tolerance policy," says Beverly Kirchner, RN, BSN, CNOR, CASC, the president and CEO of Genesee Associates and the study's lead researcher. "Everyone must understand the consequences bullies will suffer in the workplace."
More than 500 RNs who answered the survey detailed patient safety breaches that occurred when horizontal violence was present in the healthcare workplace. Some likened the experience to being battered spouses.
"If you have a bully in your workplace, you will find her behavior is malicious, health-endangering and repeated," says Ms. Kirchner. "If the behavior is not stopped, the work environment can become hostile and everyone will suffer. If bullying is ignored, the entire organization is placed at risk for employee trauma, possible litigation and adverse consequences for patients."
What does a bully look like? Here is a profile:
The target's profile looks like this:
Knowing these traits, researchers believe they can further explore the dynamics between the bully and target. The target enters the bully relationship involuntarily. The bully has control, deciding when and where to attack, when to hold back and what audience will view the behavior. Control is the bully's ultimate goal. There are four types of healthcare workplace violence, according to bullying experts Gary Namie, PhD, and Ruth Namie, PhD. They include verbal, psychological (mix of verbal, non-verbal, and "planned" attacks), physical and sexual assault.
The three types of bullies:
"In a social setting - work is a social setting - a target can feel isolated, betrayed or abandoned by co-workers," says Ms. Kirchner. "Financially, we can suffer due to loss of job or simply by having to take days off to avoid the bully."
- Dan O'Connor
Break Out Your Yardsticks
Do Your ORs Measure Up?
Two changes of note from the AIA's 2006 Construction Guidelines, which are updated and published every five years.
"The problem with these two changes is that once the facility is designed and constructed, it's nearly impossible to make the adjustments necessary without compromising the revenue-generating ability of the surgery center," says Wade Taylor, AIA, of Wade Taylor and Associates Architects in Milwaukee, Wis.
- Dan O'Connor
Benchmarking Snapshot
Nobody Likes Cancellations
Be they after admission or after anesthesia induction, cancellations create a cascade effect on your patients, your physicians and your surgical department. The AAASC Clinical Benchmarking report shows that 0.69 percent of the average facility's cases are canceled after admission and 0.02 percent after induction. The result of cancellations?
In the Know
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