AMSURG Leads the Way in Improving Patient Safety in Scope Reprocessing

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AMSURG is on the cutting edge of quality improvements with a new education program aimed at focused training requirements for the healthcare professionals who reprocess endoscopes in AMSURG surgery and endoscopy centers.

The new program, which was eighteen months in the making, launched in March of this year. It requires all staff who participate in reprocessing endoscopes between gastroenterology procedures to complete comprehensive training and demonstrate detailed competencies on the highly technical steps. To date, more than 1,000 healthcare professionals have begun the training program.

"We wanted the assurance that staff at our centers were getting the best, most accurate information and we needed to be able to verify the accuracy of the processes they are following. This program provides both of those," said Charles Logan, associate vice president of quality, clinical services. The comprehensive training has also provided a way for AMSURG Center Leaders to become more knowledgeable about the requirements of scope reprocessing.

Recently, attention from regulatory bodies and professional societies is becoming increasingly focused on endoscope reprocessing as an area for improving patient safety. The Association for the Advancement of Medical Instrumentation (AAMI) recently issued a recommendation that all personnel performing processing of endoscopes receive training and complete a certification exam when hired and annually, at a minimum. AMSURG's scope reprocessing education program meets or exceeds these recommendations.

"We fully expect industry standards to continue becoming more prescriptive, but we did not want to wait for that to happen. We made this program a top priority because of its direct impact on patient safety," said Kathy Wilson, vice president of quality, clinical services.

The AMSURG clinical quality department continues to build additional tools and training resources for scope reprocessing, equipping centers to differentiate themselves in patient safety and become centers of choice for both patients and physicians.

Top 6 Challenges When Building a New ASC

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Building a new ambulatory surgery center (ASC) is no small project. After 35 years designing and constructing ASCs, AMSURG's Vice President of Real Estate and Planning, Daniel Buehler, offers an overview of the most common ways a development project can become derailed.

1. Team

"You have to hire the right people," Buehler said. Choosing a team with expertise in healthcare–and ASCs specifically–will drastically improve the development process for the physician owner. "Physician owners rarely have the time to lead a building project themselves, so having a nurse manager or center director driving the project on behalf of the physician can bring an in-depth knowledge about center operations and help to move the project along."

"This is one of the areas where AMSURG Facilities Management and Construction stands head and shoulders above the rest," Buehler confirmed. "When beginning a new building project, we will propose a complete team: architect, engineers, contractors, etc., all of which we have vetted and can confidently recommend."

"I would pit my AMSURG team against any in the world. Each project manager has at least 20 years' experience and we also bring invaluable clinical background knowledge as well."

2. Time

Once you have a team assembled, you want to start early, about 24-36 months before you want to see a patient, according to Buehler.

"Before you get started, you need to have a strategic planning session. What are your short and long term goals for the center? An achievable goal will provide focus for the project and get everyone on the same page."

3. Money

When building a budget for your project, be sure to include all the different kinds of costs: hard costs (construction, construction fees, permits), soft costs (consulting, design, legal), cost of money (interest, carry costs, construction loans), equipment costs, other start- up costs (phone systems, signage, etc.)

"When we get a new project underway, we put together a comprehensive budget that includes all of these costs so that our partners have a realistic expectation of costs from the beginning."

4. Size

"Size is the Achilles heel of ASC development. In the ASC world, bigger is not better. Better is better."

A larger space means higher costs, both up front and continually through rent, utilities, and operational costs. You end up needing more staff to cover more space, which is inefficient. But a smaller ASC can have leaner processes, staffing and costs, making it more profitable.

5. Design

A well designed facility will improve and streamline the processes of the center. Patients, staff, equipment and materials all flow into and throughout the ASC. "At the end if the day, though, everything we do is balanced against patient safety and quality of care. It all begins with careful and thoughtful design".

"What you want is a design that not only allows all of these flows to occur smoothly and simultaneously but also to complement one another," Buehler said. Working with an architect who has experience in designing surgery centers can end up having a big effect on operations long after move-in day.

6. Regulations

When building a new ASC, you have to take into account a variety of regulations from CMS, local, state and federal codes, as well as accrediting agencies. Navigating all of these sometimes competing requirements takes expertise, knowledge and an eye for detail.

"I am proud to say that we have never lost time moving into a center because of a mistake we've made with regard to regulatory requirements," Buehler said.

For more information about partnering with AMSURG to build an ASC, call 877-741-0085 or e-mail partnerships@amsurg.com.

AMSURG Sponsors Health:Further 2016

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AMSURG participated in Health:Further 2016 on August 23-24 in Nashville as a sponsor of the conference’s Provider Track, including an introduction from AMSURG’s President of Ambulatory Services, Phillip Clendenin and a presentation from Chief Quality Officer for Physician Services Gerald A. Maccioli, M.D. Dr. Maccioli discussed the implications of the Medicare Authorization and Chip Reauthorization Act (MACRA) for physicians. Created by JumpStart Foundry, Health:Further brings healthcare entrepreneurs and investors together in an effort to build partnerships that innovate the future of the rapidly-changing healthcare market. With its combination of keynotes, panels and tech startup showcases, Health:Further provides opportunities to “further the dialogue on innovation in [the healthcare] industry.” The “Volume to Value” revolution is one such opportunity for innovation. Dr. Maccioli’s Provider Track presentation explored the complexities of MACRA and the unique opportunities and challenges providers face in the shift from volume-based fee-for-service payments to value-based payments spawned by this legislation. MACRA seeks to empower doctors and reduce the administrative burden by allowing physicians and practitioners to be rewarded for providing excellent care at lower costs. “If physicians are asked to co-lead in the volume-to-value revolution, it will succeed; if not, it will fail,” commented Dr. Maccioli while discussing the unique partnership opportunities physicians face in this healthcare shift. AMSURG’s Chief Information Officer Eric Thrailkill along with Kimberly Franks, vice president, information technology, and Dave Killean, division vice president, operations, are working with Jumpstart Foundry to gain access to innovation opportunities at AMSURG. With the help of JumpStart, Thrailkill and his team have met with 16 startups focused on driving healthcare solutions. “There are over 7,000 digital health IT start-ups today…far too many to vet in a rapidly changing environment,” Thrailkill said. “We have defined innovation ‘buckets’ of interest at AMSURG focusing on care delivery models, efficiency models and patient engagement initiatives.” Three of these startups: GreenlightMedical, Calibrater Health and Beckoncall have visited AMSURG to explore new growth opportunities in digital health.

AMSURG Focuses on Creating and Sustaining Cultures of Safety

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Optimizing patient outcomes by improving communication and teamwork was the goal for the TeamSTEPPS Master Training course that all AMSURG Clinical Quality team members completed in July. Held at AMSURG's Nashville headquarters, the Master Training course featured an in-depth train-the-trainer approach.

The two-day session, led by a team from the University of Washington, brought techniques, tools and innovative solutions to assist the AMSURG Clinical Quality team in successfully implementing and sustaining TeamSTEPPS principles of communication, leadership, situation monitoring and mutual support.

"This training is about empowering our Senior Clinical Directors with better knowledge to carry to our centers and equipping them with the know-how to help center staff improve the quality of care they're delivering," said Debbie Cibulka, vice president, clinical risk management. After the intensive training, all AMSURG Clinical Quality team members are now certified master trainers and will be training staff at various AMSURG surgery centers throughout the next year.

"You can strive all day long to try to do the best you can, but unless you have protocols in place that have been practiced to the point of habit, you're still going to be prone to errors," said Sarah Martin, vice president, clinical services.

Medical team training programs have been shown to reduce annual surgical mortality rates and adverse events. "The quality of patient care is equal to the quality of communication and planning," Martin said. "This training will be an invaluable asset to AMSURG Clinical Quality moving forward. We are committed to excellence and to providing accessible and proven tools for building a culture of safety in each of our centers."

A Focus on Patient Safety Shines Through AMSURG Center Leader Ideas for Creating a Culture of Safety

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AMSURG surgery centers are leading the way in creating a culture of safety. In honor of National Safety Month in June, AMSURG centers in various specialties answered the question: "How do you create a culture of safety in your center?"

The Center Leaders highlighted opportunities for strategic communication about patients, processes and procedures, including during staff meetings and timeouts. They provided ideas for enlisting staff members to be engaged in patient safety and for sustaining that engagement day in and day out.

Center Leaders are encouraging staff to view themselves as patient advocates and to speak up if they are concerned about a patient safety issue. Ideas were submitted via AMSURG's secure communications portal, Center Connect. The portal provides AMSURG Center Leaders and their staff with best practice performance improvement modules, financial reports and operational benchmarking reports, quality assurance performance improvement (QAPI) reports and opportunities to learn what other AMSURG centers are doing in their efforts to become centers of choice for physicians and patients.

Some of the best practices that were offered include:

  • Discussing patient safety in each staff meeting
  • Patients always being escorted to their family members or to their car
  • Fully engaged participation in timeouts
  • Encouraging nurses to speak up about concerns
  • Having staff participate in creation of patient safety posters
  • Including verbal reminders during patient hand-offs

This initiative to gather best practices from centers is one example of AMSURG's collaborative culture, illustrating the value the company places on the ideas and strategies its centers are putting to the test and the need to share those proven strategies between all centers.

Fecal transplants in an outpatient endoscopy setting offer big reward with little risk

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Patients often go to hospitals for fecal transplants, but according to Paul Allegretti, M.D., many patients are healthy enough to have the procedure performed in endoscopy center or ambulatory surgery center (ASC).

“AMSURG was great because they had had some preliminary research, preliminary data on how to put something like that in an endoscopy center,” Allegretti said. “I had written a protocol with the help of another physician who sort of pioneered fecal transplant from a physician end of it. So that protocol was in place, they reviewed it. [They] really were great. No significant interference. Everything they had to say was really additional info that was helpful in getting it on board.”

Allegretti, an AMSURG physician partner at Lancaster Gastroenterology Procedure Center in Lancaster, Pa., has been a long-time proponent of using probiotics to treat gastrointestinal diseases, but the increase of Clostridium difficile (also known as C. difficile or C. diff) infections over the last several years has caused him to focus particularly on fecal transplants.

“The reason I started doing fecal transplants was, I always had kind of an interest in the microbiome and the bacterial contribution to gastrointestinal disease,” Allegretti said. “More and more, as time is going on, you see C. diff throughout the hospital becoming much more common than it was even when I was a medical resident, even more common in the community than it was 5 to 10 years ago. So in the short time I’ve been practicing, it’s become really a difficult disease to manage with what we had, which were just antibiotics. So seeing this becoming a new way to treat something and having the success rates that it had really kind of pushed me to work towards getting this procedure locally.”

Anyone can become infected with C. diff, but those who have been recently treated with antibiotics are most vulnerable. When antibiotics fight off harmful bacteria, they also destroy the healthy bacteria that protect the body against infection, leaving the body susceptible to C. diff. Once a C. diff infection is established, the bacteria release toxins that attack the lining of the intestine. C. diff infections can range from mild to life-threatening.

Fecal transplants are a highly successful way to treat the increasing number of patients infected with C. diff. According to a new review, infusion of healthy bacteria through donor stool helped 55 percent of patients heal who did not respond to standard drug treatments. Fecal transplant helps break the cycle of recurrence for C. difficile. With a fecal transplant, 90 percent of people improve.

In July of 2013, the U.S. Food and Drug Administration (FDA) dropped the regulation that required doctors to complete an investigational drug application before performing fecal transplants. According to Allegretti, this decision greatly contributed to making fecal transplants more accessible to interested practitioners.

“That really opened it up to people who were interested in doing it that maybe didn’t have a full university staffing behind them to do all the paperwork that’s sometimes involved," said Allegretti. "So, less paperwork allowed it to be done.”

Overall, Allegretti said that the reaction from patients has been quite positive. Most patients turn to the internet to do their own research, and they come into the office well-informed and asking good questions.

“They ask about our own success rates. They ask about success rates nationally. They want to reiterate what the positive research has shown. They ask a lot of questions about the donor – who is an appropriate donor – and they ask a lot of questions about cost, because that’s something you can’t really find on the internet necessarily," said Allegretti.

Allegretti added that many patients have concerns about the cost of the procedure, but it typically turns out to be quite affordable with insurance coverage.

For physicians who are interested in offering fecal transplants, Allegretti offered these recommendations.

“The best advice to give other gastroenterologists who might be considering this procedure is to make sure you, obviously, review literature, have your protocol in place before you present, make sure you’re well-read so you can answer any questions that an advisory board or a safety board or your nurses will have," said Allegretti. "A lot of questions pop up in the process, and generally these questions are answered by prior research, prior protocols that are available. So if you’re able to be well-read in those, it’s pretty straightforward, very rewarding and worth it once you’re able to do those things.”

Click here to watch the complete interview with Dr. Allegretti. Be sure to subscribe to our YouTube channel and be notified when AMSURG physician partners discuss surgery center insights and their experiences with an AMSURG partnership.

How a corporate partnership can bring ASCs to the next level

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When it comes to ambulatory surgery centers (ASCs), the right corporate partnership can make the difference between surviving and thriving. Ophthalmologist Kerry Solomon, M.D., of the Physicians’ Eye Surgery Center in Charleston, S.C., believes that AMSURG has been his center's key to success.

“I think what makes AMSURG a good partner is they understand the eye business. I think they also understand the importance of having a true partnership with physicians. Not everybody does that,” he said. “Prior to my being here I was at a corporate entity, a university-based hospital, and it really was not the case. It’s hard to have a corporate entity understand your business, yet let you do what you want to do.”

Dr. Solomon shared some of his initial concerns when considering a corporate partnership with AMSURG, but explains that his uncertainties were quickly put to rest. “When we owned 100 percent of the center, we were ok to make investments in new technology or new things, regardless of the expense, if we felt it was in the best interest of our patients. Yet we were concerned that bringing a corporate partner in may alter that,” he explained. “But everyone I called said that’s absolutely not the case with AMSURG. In fact, your day-to-day running will be no different than it ever was, and your decision making should be pretty similar to the way it always was, yet AMSURG provides great resources if you need them. And that really has been exactly the case.”

Regarding the future of his practice, Solomon feels certain that AMSURG will be a key component helping them advance to new levels. “There’s no question AMSURG is going to bring us to new places in the future. We can already see it as we’re looking to position ourselves for accountability care organizations and the Affordable Care Act and things along those lines. I do think they’ll be able to help us in negotiations.”

“The partnership is going better than I thought it could possibly be going, and I really went into the partnership with a lot of comfort and a lot of reassurance and a great deal of confidence that this would be successful,” Solomon explained. “They’re good people. They understand the business. They’re good to work with.”

Solomon is a well-recognized leader in ophthalmology, specializing in LASIK vision correction and cataract surgery. He was awarded TOP Doctor by US News & World Report in 2013 and currently serves on the editorial board of Premier Surgeon magazine.

Click here to watch the complete interview with Dr. Kerry Solomon. Be sure to subscribe to our YouTube channel and be notified when AMSURG physician partners discuss surgery center insights and their experiences with an AMSURG partnership.

Improving Patient Experience with Online Registration

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Patient registration can be a cumbersome process. Eye surgery center patients generally have complex health histories, long lists of medications and, of course, less than stellar vision. Collecting patient histories and paperwork is no small challenge.

Early this past year, several AMSURG ophthalmology centers transitioned to online patient registration. Online patient registration offers several advantages:

  • Patients can fill out patient histories at any convenient time, from the comfort of their home where their medicines and records are nearby. As necessary, their adult children or other caregivers can readily assist them
  • The process includes digital signing of release forms, simplifying the check-in process
  • Each center customizes the information collected to meet its needs. Once collected, the information can be printed out in an easy-to-read, consistent fashion
  • A dashboard tracks which patients have submitted their information. Those considered to be high risk, based on criteria provided by each center, are highlighted so that staff can follow up
  • For the second eye or any subsequent surgery, patients can log in and update their history, rather than having to provide the same information again

Center Leader Georgia Voss, The Eye Surgery Center in Silver Spring, M.D., has become a strong advocate for the program: "Using online patient registration has been a real help to our center. About 85 percent of our patients go online to fill in their information, which is a huge time saver. It improves the patient experience at the center because the check-in process is so much simpler for the patient."

Voss's center made the commitment to get every patient registered online. For patients who don't register themselves, a nurse calls the patient, collects the information and enters the data for them. The center even offers access to a computer for patients who don't have access elsewhere. "It has been hard work, but we believe it helps us give the best possible patient care," Voss said.

Incorporating online registration is one of the ways AMSURG centers can earn Cataract Innovator™ status. AMSURG launched the Cataract Innovator program in 2013 as a way to recognize centers for going above and beyond standard best practices in order to improve patient experience. Eye surgery centers with the distinction of being a Cataract Innovator always strive to provide the best patient experience possible and are dedicated to using the most up-to-date technology and research to provide outstanding treatment. Cataract Innovators are part of AMSURG's large network of outpatient eye surgery centers, where more than 100,000 procedures are performed each year.

How outpatient orthopaedics can benefit from ASC management partnerships

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With the advancements in total joint replacement surgery, more procedures are moving to an outpatient setting and starting the conversation of why to consider a surgery center management partnership.

“I think it’ll be commonplace 10 years from now where, if you have reasonably good health and you have a total knee or total hip, it will be done in a completely outpatient setting,” said AMSURG physician partner Lee Hunter, M.D., orthopaedic surgeon at the Surgery Center of Middle Tennessee. “[The] spine is not really my level of expertise, but I think many cervical disc fusions and standard lumbar cases, including some fusions, may be done as an outpatient surgery.”

Hunter offers valuable advice for practitioners who are interested in offering outpatient procedures in their facilities.

“As new procedures are done in an outpatient setting, there is a little bit of a learning curve, and there are certainly things that are easier to accomplish and things that are harder to accomplish. So I would say do something that you know is going to work,” Hunter said.

“Make sure you’re well prepared, those around you are well prepared, and basically plan for the worst. Make sure that your follow-up care, if there’s a rehab stay involved, is seamless and lined up before it comes to the launch day.”

Even with the best preparations in place, Hunter warns that there are will still be obstacles, and this is where it helps to have a surgery center management company partner to aid in that transition.

“If the partner takes over operational day-to-day management, either in conjunction with the physician team or completely takes it over, I think that lets the physicians practice medicine and worry less about the day-to-day issues, the hiring and the firing and the other things that go with the HR department," Hunter said.

A corporate surgery center partner can make the transition of a procedure to the outpatient setting easier by providing best practices, necessary documentation and connections to physicians who have already made a similar transition. It can also provide centers and physicians with research and information to help them stay competitive with other centers.

“AMSURG has been very, very good at tracking data within their centers and comparing that to data, available data nationally,” Hunter said. “We’re benchmarked, our center, to every other AMSURG center. We can compare that data. We compare our data on costing, what it costs for a suture anchor from this company here versus a suture anchor from the same company out in California, and all that is very, very useful as we negotiate contracts and really see where we stand. So I think AMSURG has been very useful [in providing] that data we otherwise wouldn’t be able to get.”

Click here to watch the complete interview with Dr. Hunter. Be sure to subscribe to our YouTube channel and be notified when AMSURG physician partners discuss surgery center insights and their experiences with an AMSURG partnership.

AMSURG Achieves Tennessee Record LEED Certification

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After several years of moving around the Burton Hills office complex in Nashville's Green Hills community, it became clear that AMSURG needed a building of its own to continue to grow. That need produced a custom designed space right around the corner. The new location provides capacity for increased customer service, marketing and leadership functions to support the company's physician and surgery center partners.

There were big plans for the new headquarters from its inception. The moment AMSURG began working on the space the goal was to be as ecologically responsible as possible. This desire led to AMSURG’s new location being recognized as the largest gold-certified LEED (Leadership in Energy and Environmental Design) building in the state of Tennessee.

“We knew right from the beginning that we wanted to go about the design responsibly. Pursuing LEED certification was just the logical extension of that desire,” asserted Ashely Coleman, associate vice president of construction.

LEED certification is an extensive system of points and regulations that ensure a building is paying attention to things like environmental sustainability and energy efficiency. As simple as this sounds, there are always obstacles, both expected and surprising, that complicate the process.

One such complication came to light when the foundation of the building was being excavated. There was an unexpected natural spring. Construction turned this surprise into an advantage by utilizing the spring for the building's HVAC cooling tower.

LEED certification also emphasizes local sourcing. For that reason all materials in the Burton Hills location come from within a 500-mile radius, most from much closer. However, it is with the decorations and conference room naming that AMSURG really brought in some hometown flair. Photographs and paintings throughout the building depict areas all across Tennessee and each conference room is clustered into groups of Nashville favorites such as Cheekwood, Loveless Cafe, Ryman Auditorium and Vandyland.

By creating an exceptionally ecologically responsible building, AMSURG not only built an optimal workspace for its employees to continue to serve its surgery center partners, but also an optimal structure for the city of Nashville and Tennessee. In the end, everyone wins.