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Care shouldn't stop once lights are out

Ambulatory Safety Monitor, August 25, 2004

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Although you may list your business hours as 9 a.m. to 5 p.m., Monday-Friday, an accredited ambulatory surgery center (ASC) knows that's not exactly accurate. Patients who have undergone surgery may find that once they go home, their pain worsens or they experience symptoms they aren't sure how to handle. The surgery center must have a policy in place to tend to after-hours needs.

AAAHC standard 1.F.4 says information must be available to patients and staff concerning provisions for after-hours and emergency care. Similarly, the JCAHO says when choosing an ambulatory center, patients should ask whether the organization has a 24-hour telephone number to call if complications arise after a procedure. ASCs should consider who will answer that call and how to deal with after-hours emergencies. JCAHO standard PC.5.10 also says the organization shall provide care, treatment, and services individualized and appropriate to the patient's needs, strengths, limitations, and goals. For more information go to www.jcaho.org/quality+check/guides/ac.htm

Prevent problems with postoperative information

Arm your patients with explicit information on what they should do after surgery. Most patients experience pain after surgeries, but you need to make patients aware of this so they know it is normal and not cause for alarm.

Although postoperative information will vary depending on the surgery, give all patients the following instructions:

• If given medication for pain, take it so your pain isn't overwhelming
• Rest if you've had anesthesia
• Don't drive if you've had anesthesia
• Avoid signing important documents following anesthesia
• Refrain from making important decisions after you've had anesthesia
• If your patient has had anesthesia, talk to a family member or a responsible party about the postoperative information and have the nonanesthetized person sign off on the instructions.

What message are you sending?

Patients may still have questions after reading their postoperative information. The AAAHC and the JCAHO don't define exactly what ASCs should do after hours, so each facility must establish a policy that serves its needs.

For some, it's a recorded message. Regardless of what information you leave on a machine, the first instruction should be that if patients have an emergency, they should hang up and dial 911. Some surveyors will call an organization after hours to see what information is on its recorder, says Margaret Bridwell, MD, an AAAHC surveyor who spoke during the "Achieving Accreditation" conference in Seattle in June.

Other facilities, such as Healthsouth SurgiCenter at Woodward Park in Fresno, CA, where Dee Patrick, RN, BHA, is the administrator, use answering services with a live operator to direct patients. According to Patrick, the service provider also tells patients to dial 911 for emergencies or call their physician, or the service may contact the administrator or director of nursing (DON). The administrator or the DON assists patients by assessing their complaints and will encourage them to review the postoperative instructions or call the physician's office with symptoms. Remember to list the phone number in the patients' postoperative instructions.

Most often, the patient calling is nervous about the pain he or she is experiencing and needs reassurance from a healthcare professional. Patrick and Jepsen are both available for their centers' patients after hours.

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