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July 2009 See the full issue

Applying the Surgical Apgar Score

"This patient is a 10. Everything went well." Or "This patient is a 5. She will need close monitoring." Before long, physicians and nurses may be using a numerical score like this when transferring patients from the OR to the next level of care. Researchers have validated a 10-point Surgical…

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By: Pat Patterson
July 1, 2009
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Educating patients on SSI prevention

Though the Joint Commission is in the midst of revising its National Patient Safety Goals, organizations are expected to continue plans to meet the goals by Jan 1, 2010. Proposed revisions were issued May 12 for a 6-week field review. Final goals are expected in October. The commission is conducting…

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By: Pat Patterson
July 1, 2009
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The research on OR time allocation

What criteria should be used to make decisions about adjusting block time? Traditionally, OR committees have used surgeons' utilization of blocks. But OR utilization isn't the best way to make this decision, the research shows. The method to use depends on why block time is being adjusted, notes Franklin Dexter,…

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By: OR Manager
July 1, 2009
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RACs: What is the OR's role in readiness?

After some delay, Medicare's program to have outside companies audit claims is getting underway. The companies, called recovery audit contractors (RACs), will be checking to see that claims filed by hospitals, physicians, and other providers follow Medicare policies and procedures. OR Manager asked Keith Siddel, MBA, an expert on health…

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By: OR Manager
July 1, 2009
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A vendor policy for a large system

An effective plan to manage vendors is crucial for any OR, but designing such a system for a large health system is complex. Nurse leaders at the Sisters of Mercy Health System, based in St Louis with 19 hospitals in 4 states, have collaborated with their colleagues to craft a…

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By: Cynthia Saver, RN, MS
July 1, 2009
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Settlement on kyphoplasty billing

In the first settlement of a national investigation, HealthEast Care System agreed in May to pay the federal government $2.28 million to settle allegations that 3 of its hospitals overbilled Medicare for kyphoplasties. Some 100 hospitals are under investigation, according to the legal expert who represented HealthEast. The investigation is…

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By: OR Manager
July 1, 2009
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Fine-tuning the block schedule? Now could be the right time

If you want to fine-tune the block schedule, now may be the time. A silver lining of the recession is that surgeons and staff may be more accepting of changes to the schedule than they might be otherwise. With the decline in elective surgery from the economic downturn, surgeons are…

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By: Pat Patterson
July 1, 2009
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Solving the patchwork quilt of credentialing for vendors

Would you like to be on 60 Minutes and answer the question as to why the supplier who had TB was allowed in the OR?" asks Tom Hughes, MBA, executive director for Strategic Marketplace Initiative (SMI), a nonprofit consortium of providers and suppliers from the healthcare supply chain. "Let's head…

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By: OR Manager
July 1, 2009
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A toolkit for managing block scheduling

HCA Inc, the national health care company, has developed a block scheduling toolkit for its 165 hospitals. The toolkit includes decision points, algorithms for managing blocks, and sample policies. Here are HCA Inc's 10 decision points for block scheduling. 1. Is this the right time for block scheduling? About 75%…

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By: OR Manager
July 1, 2009
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Testing practices need a closer look

Is too much preoperative testing being done for ambulatory surgery patients? New research suggests testing practices may need a close look. "If anesthesiologists are just ordering tests as a routine, they need to look at our study and re-examine what they're doing," advises Frances Chung, FRCPC, a well-known researcher in…

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By: OR Manager
July 1, 2009
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ASCs seek to get policy message across

Ambulatory surgery centers (ASC) have been getting more attention from regulators and health policymakers over the past year, and not all of it has been welcome. From quality reporting legislation to Medicare payment issues, ASCs have been under review. That is due in part to efforts by hospitals to curtail…

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By: Paula DeJohn
July 1, 2009
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Surgical Care Improvement Project: Four years later, what's the status?

Four years ago, the Surgical Care Improvement Project (SCIP) was launched, with the ambitious aim of reducing 3 types of preventable complications by 25% by 2010: surgical site infections perioperative heart attack deep vein thrombosis and pulmonary embolism. SCIP is a national quality partnership led by 10 organizations and agencies…

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By: Pat Patterson
July 1, 2009
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SCIP: VTE prevention controversy

An orthopedic surgeon announces she is revising her orders to call for aspirin as the sole prophylaxis for venous thromboembolism (VTE) for her patients having total joint replacement who are at a standard risk for both pulmonary embolism (PE) and bleeding. She refers to guidelines from the American Academy of…

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By: OR Manager
July 1, 2009
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New SCIP measures being introduced

One more SCIP measure is added for reporting for fiscal year 2010. Two more are proposed for fiscal 2011 as part of the Surgical Care Improvement Project (SCIP). Beginning Oct 1, 2009, the start of FY 2010, one more measure will affect hospitals' Medicare payment update: Surgical patients on a…

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By: OR Manager
July 1, 2009
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SCIP: Getting everyone on board

OR Manager asked Dale Bratzler, DO, MPH, who coordinates the Surgical Care Improvement Project (SCIP) to respond to readers'questions about the project and getting all practitioners on board Q Who develops the SCIP measures? Are practicing physicians involved? Dr Bratzler: SCIP performance measures are developed by Technical Expert Panels, which…

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By: OR Manager
July 1, 2009
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Never events': Sorting out confusion

There's a lot of discussion about Medicare no longer paying for "never events." Surprisingly, so far, the policy has had little financial impact. Until recently, Medicare hadn't given instructions about how claims for these events should be handled. There is also confusion about how Medicare defines a "never event" for…

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By: OR Manager
July 1, 2009
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Surveyors to shift sterilization focus

The Joint Commission announced in June it will look beyond flash sterilization to take a broader view of sterilization. Surveyors will scrutinize the entire process rather than just focusing on which sterilization method is selected. "If a complete and effective process of sterilization is used, it will be considered an…

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By: OR Manager
July 1, 2009
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Engaging your staff in hard times

An engaged workforce is more important than ever in the hard economic times facing OR managers and their facilities, says Jo Manion, RN, PhD, FAAN, NEA-BC, an author and management consultant. "A positive manager asks, 'How can we use this challenge?'" Manion told OR Manager in a June interview. Her…

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By: Kate McGraw
July 1, 2009
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Recouping costs on out-of-network

As if collecting payments from Medicare, Medicaid, and private insurers wasn't complex enough, ambulatory surgery centers (ASCs) face the added obstacle of being considered out-of-network by payers in many circumstances. Out-of-network typically means an ASC does not have a participation agreement with the payer or managed care organization or is…

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By: Paula DeJohn
July 1, 2009
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Staying on top of code requirements

It is not enough to prevent infection and always to identify the right surgery site. It is not enough to have smooth hand-off procedures and to question patients thoroughly about their allergies and ailments. To keep patients (and employees and visitors) safe, the very architecture of an ambulatory surgery center…

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By: Paula DeJohn
July 1, 2009
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90-day guarantee: Warranties as a tool for improved patient outcomes

Everything from washers to cars comes with a warranty, so why not health care? Geisinger Health System in Danville, Pennsylvania, introduced health care warranties with an innovative program called ProvenCare. Under the 90-day warranty, one cost covers the surgery and 90 days of follow-up treatment. Geisinger absorbs any additional costs…

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By: Cynthia Saver, RN, MS
July 1, 2009
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