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New staffing structure builds on success of specialty team model

Less than a year after adopting a “college structure” model akin to that of specialty teams, the UF & Shands Academic Health Center in Gainesville, Florida, is close to achieving a goal of 100% on-time starts. “We track first-case start times, and a report goes out every morning, so we’ll…

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By: OR Manager
July 1, 2013
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Focus shifts to device fragments, small miscellaneous items in RSIs

Though retained surgical items (RSIs) cases are rare, they do happen, and they take a heavy toll throughout the system in terms of steep fines, malpractice claims, and compromised patient safety. Estimates of RSIs range from 1 in 1,000 to 1 in 7,000 procedures. And a 2003 study by the…

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By: OR Manager
July 1, 2013
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July Editorial

Hospitalizations involving a lost sponge or instrument cost more than $60,000 on average, and related malpractice suits can cost hospitals between $100,000 and $200,000 per case, according to a March 8 USA Today article on retained surgical items (RSIs). “For many hospitals, lost sponges and other surgical items aren’t considered…

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By: OR Manager
July 1, 2013
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OR noise levels linked with increased risk for error

Noise in the OR, whether it is the sound of loud equipment, talkative team members, or music, is a patient and surgical safety factor that can affect the processing of auditory information by surgeons and other members of the OR team, finds a study. The study is the first to…

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By: OR Manager
July 1, 2013
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‘Just Culture’ encourages error reporting, improves patient safety

During a procedure in the OR, a medication is retrieved from the automated supply station and introduced onto the sterile field. The sterile field is then, unknowingly and unintentionally, contaminated by an unsterile medication. This example could happen in any operating room setting. In this case, the circulating nurse spoke…

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By: OR Manager
July 1, 2013
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Unprocessed tray incident prompts investigation, leads to process improvements

The circulating nurse was cleaning up after surgery in an ambulatory surgery center (ASC) when she noticed the internal chemical indicator (a Class 5 integrating indicator) had not reached its appropriate endpoint response, which is a pass. That meant an unprocessed instrument tray had been used on the patient. Her…

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By: OR Manager
July 1, 2013
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Fewer surgical cancellations occur after preoperative screening

Duke University Hospital has had a Pre-Operative Screening Unit (POSU) in place for the past 16 years to optimize patients prior to surgery, but until recently, there were no hard data on surgical cancellation rates. Now, a retrospective analysis has revealed that fewer cancellations occur when patients are seen in…

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By: OR Manager
July 1, 2013
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Can your OR documentation stand up to a RAC audit?

A column on managing the OR revenue cycle.   Audits of Medicare payments to hospitals are up dramatically. In all, 89% of hospitals reported activity by recovery audit contractors (RACs) in the third quarter of 2012, according to an American Hospital Association (AHA) survey. Here are tips on how your…

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By: OR Manager
July 1, 2013
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Taking small steps to control supply costs yields a much better bottom line

OR Business Performance is a series intended to help OR managers and directors improve the success of their business.   Surgical supplies are a major cost category for hospital ORs. Depending on the specialty and the procedure, supplies may represent 50% or more of total costs per case. Unfortunately, new…

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By: OR Manager
July 1, 2013
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Guidelines addressing preoperative assessment of geriatric patients aim to enhance outcomes

The number of elderly people in the US is on the rise, and so is the number of older patients having surgery. However, while advances in technology and techniques may make surgery more feasible for those age 65 and older, ensuring successful outcomes for this cohort is challenging. Specific guidelines…

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By: OR Manager
July 1, 2013
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New CMS guidelines suggest changes in advance directive policies

Ambulatory surgery patients who become incapacitated should have their wishes for care honored, the Centers for Medicare and Medicaid Services (CMS) stresses in its new guidelines. Previously, the guidelines permitted an ambulatory surgery center (ASC), for reasons of conscience or policy, to refuse to honor advance directives calling for cessation…

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By: OR Manager
July 1, 2013
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ASCs must prepare to meet latest CMS infection control expectations

A perennial concern associated with surgery is avoidance of infection. As science reveals new risks and remedies, protocols change and so do regulations. To monitor infection control at ambulatory surgery centers (ASCs), surveyors use a 15-page worksheet from the Centers for Medicare and Medicaid Services (CMS). The ASC Infection Control…

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By: OR Manager
July 1, 2013
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