In surgery, efficiency and standards are maintained by adhering to processes and procedures. By organizing surgical instruments, having a well-trained team, and using checklists, we can optimize efficiency and maintain a high level of safety for patients and staff. This also helps improve outcomes and patient satisfaction.
Of course, there are times when things do not go as planned. However, a well-trained team with access to “just-in-case” instruments and devices can help a complex case remain without or with minimal complications. Preoperatively, surgeons routinely review cases and should share any specific concerns with OR staff. This may include potentially complex situations, such as the need for sutures, additional or specific viscoelastics, potential access to iris retractors or iris dilation rings, and vitrectomy. The staff should be familiar with the names and locations of different devices and materials, as well as the setup and use of these “one-off” devices. This may include loading capsular tension rings or 3-piece intraocular lenses in addition to setting up vitrectomy and suture sets.
The OR director or lead surgical technician should review these procedures with staff on a monthly or quarterly basis to be sure that everyone is knowledgeable. New staff should have onboarding that includes this training, and industry representatives can be a good resource to assist with this education. Prior to implementing a new device or procedure for the ophthalmic ambulatory surgery center (ASC), it is useful to have the surgeon and staff stage a “dress rehearsal” to troubleshoot and avoid potential problems and pitfalls and streamline workflows.
Having a dedicated person to maintain quality assurance and provide the structure and framework by which this is measured is a necessary component for any ASC. This manager is tasked with overseeing patient safety, clinical quality, and regulatory compliance. Fostering a culture of open communication and continuous improvement with ASC staff and the surgeons who use the center is mission critical for success. A breakdown in communication can lead to a breakdown in patient safety.
Involving surgeons and staff in decision-making and explaining the reasoning behind decisions that affect daily operations is critical for open communication. A manager who creates rules and regulations without this communication and coordination may not achieve the respect of their staff and can be viewed as burdening the surgeons with unnecessary tasks. This is where data-driven analysis and communication can help identify roadblocks to implementation and areas for improvement.
Just as surgeons prepare staff for both routine and complex cases, the ASC quality improvement manager should ensure staff are trained on standard operating procedures as well as emergency procedures. Regular drills and reviews of protocols, infection control, and adherence to Occupational Safety and Health Administration standards and Centers for Medicare & Medicaid Services guidelines are important for audit readiness and maintaining quality standards.
Mock audits can also prepare an ASC for real or scheduled audits: All of the required documentation is ready, and staff are trained to locate and implement proper procedures and protocols. Checklists include credentialing, patients’ rights, informed consent, time-out procedures, medication management, infection control and prevention, and emergency preparedness. If the ASC is well prepared and has good leadership in quality assurance, everyone benefits.
