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Patient's death, updating policies, and other issues
By Stephen W. Earnhart, MS
Earnhart & Associates
Question: We had a patient die in our operating room last week, and we are all still devastated by it. Administration is running around making sure that everything was done properly and that everyone followed procedure, and it is just terrible. The patient came in for a simple liposuction and is now dead. How can we protect ourselves from this? We are all wondering what we could have done differently that would have changed the outcome.
Answer: The odds are in your favor, but the reality is that, sooner or later, someone is going to die in your center — regardless. Reviewing your patient and case selection criteria will help eliminate some of the risk, as will sitting down with anesthesia to review protocols. Bottom line: Every surgical procedure is potentially a life-and-death event. However, a death is always distressing for the staff, no matter how rare. Consider having a staff meeting and offering information about how to handle the stress so that they don't burn out.
Question: Our center received a three-year accreditation about three years ago. We are in the process of updating our policies and requirements and are wondering when we should date them?
Answer: Call the accrediting company and ask them. But the short answer is that you need to update your policies and procedures, protocols, requirements, etc., when they come out, not when you are being reaccredited. You will get cited if you only update your material based upon your re-cert date. Also, note that some states mandate you review all policies and procedures annually.
Question: Can we have two medical directors in our center? For political reasons, no one is willing to pick one of two qualified docs.
Answer: Sure you can. Make them both co-directors. Take a medical director's job description, and split the responsibilities. The average stipend for the medical director is about $20,000 per year, so to make it even simpler, split the stipend as well. Some centers track the hours that the medical director logs in. If you are in that situation, you may need to document hours or salary for each to get to the point where everyone is happy.
Question: Here is one you have not heard before: We have a small operating room department in the middle of absolutely nowhere. The part of town the hospital is in doesn't even have shadows. One would think that's a pretty easy job for a nurse manager, but it's not the case. We never can seem to objectively resolve issues between staff members and have resorted to all sorts of measures to be equitable in determining who gets stuck doing the nasty jobs. Do you have suggestions on how to pick someone to do something when you only have two individuals?
Answer: Sure: rock, paper, scissors.
Question: We have a small surgery center, and I am always looking for way to offer staff more money as we have virtually no overtime opportunity. We have done the obvious but are still looking for innovative ways to get them cash. Ideas?
Answer: Sure. Rotate the cleaning of the center to the staff. It is a good way to make extra money. Make sure they follow procedures with chemicals, etc.
Let the staff members make up "snack boxes" for patient families, staff, and surgeons. They buy a cute couple of baskets, go to their local discount store, buy some bulk candy bars, and mark them up to sell at the center. As a rule of thumb, hospital gift shops mark up their merchandise 100%. So can you.
Look around at your facility and see what other ideas you can come up with.
(Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 1000 Westbank Drive, Suite 5B, Austin, TX 78746. E-mail: email@example.com. Web: www.earnhart.com.)