JANUARY 2009, VOL 89, NO 1 Clinical Issues

enrichment. In 2008, AORN’s educational con-ferences featured a variety of useful topics inleadership, clinical practice, ambulatory surgery,and informatics. The annual Fall MultispecialtyConference allows perioperative nurses to ad-vance their skills, explore critical issues in theperioperative setting, and stay up-to-date withperioperative best practices. This conference fea-tures ambulatory-specific topics for the Ambu-latory Surgery Administrator Certificate pro-gram and the ASC Nurses’ Seminar.

AORN’s Ambulatory Surgery Administra-tor Certificate Program is the only comprehen-sive, ambulatory surgery-specific program ofits kind. It is designed to provide the skillsand tools nurses need to successfully and con-fidently manage key aspects of ambulatory or-ganizations, such as daily operations and reg-ulatory requirements.5

The Ambulatory Surgery Foundation’s ASCNurses’ Seminar is a one-day seminar designedto update knowledge of ASC nursing issues.Networking with ASC nurses from around thecountry is an additional benefit of participatingin this seminar. The program is for all experi-

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Quality measures for ambulatory surgery centers

QUESTION: I am a nurse manager in a large healthcare system. Recently, I moved from a periopera-tive hospital setting to an ambulatory surgerycenter (ACS) within our system. In the hospitalsetting, we used Surgical Care Improvement Proj-ect quality measures. What measures are used inASCs for reporting quality data?

ANSWER: Beginning January 1, 2009, the Cen-ters for Medicare and Medicaid Services (CMS)requires ASCs to begin collecting quality measuredata as part of the Tax Relief and Health Care Actof 2006.1 The ASC quality measures provide aframework and standardized process that organi-zations can use for data collection, measurement,and analysis for CMS reporting requirements. Ultimately, quality monitoring will lead to im-proved patient care and outcomes. Examples ofthe quality measures that the CMS will accept arethose developed by the ASC Quality Colla bora -tion (ASC QC) including, but not limited to,

• patient burns;• timing of prophylactic IV antibiotics;• patient falls in the ASC;• wrong site, side, patient, procedure, or im-

plant; and• hospital transfers and admissions.1,2

These standardized quality of care measuresfor ASCs were endorsed by the National Qual-ity Forum (NQF).3 The NQF

is a voluntary consensus standard setting or-ganization established to standardize healthcare quality measurement and reportingthrough its consensus development process.3(p1)

The ASC QC developed a tool called the ASCQuality Mea sures Implementation Guide to helpASC staff members implement the NQF-endorsed

ence levels—from those just starting out in theASC industry to ASC nurse managers.6

All of these resources focus on education,skill enhancement, and raising staff awarenessof safe patient care and following safe practices.Recommended practices and resources are ap-plicable to non-hospital surgery sites and arevaluable to managers and staff members alike.

REFERENCES1. Perioperative Standards and Recommended Practices.Denver, CO: AORN, Inc; 2008.2. Ambulatory practice resources. AORN, Inc.http://www.aorn.org/Ambulatory/AmbulatoryPracticeResources. Accessed November 11, 2008.

4. AORN educational conferences. AORN, Inc.http://www.aorn.org/Education/EducationEvents/Conferences. Accessed November 11, 2008.5. Ambulatory Surgery Administrator Certificate Pro -gram. AORN, Inc. http://www.aorn.org/Education/ProfessionalDevelopment/AmbulatoryCertPrograms/ASCAdministrator. Accessed November 11, 2008.6. ACS Nurses Seminar. AORN, Inc. http://www.aorn.org/Education/EducationEvents/Conferences/ASCNursesSeminar. Accessed November 11, 2008.

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REFERENCES1. HR6111 Tax Relief and Health Care Act of 2006:Sec 101 Physician Payment and Quality Improve-ment. Centers for Medicare and Medicaid Services.

QUESTION: We know that in 2009, the Joint Com-mission Universal Protocol™ will be revised in theNational Patient Safety Goals (NPSGs). Currently,we conduct the time out before starting the proce-dure, usually before the anesthesia process is initi-ated. In instances in which two or more proceduresare being performed on the same patient, when isthe time out performed for each procedure?

ANSWER: The 2009 Joint Commission NPSGUP.01.03 elements of performance state that thetime out should be performed immediately be-fore the start of a procedure:

The purpose of the time-out immediately beforestarting the procedure is to conduct a final as-sessment that the correct [patient], site, position-ing, and procedure are identified and that, as applicable, all relevant documents, related infor-mation, and necessary equipment are available.1

The Universal Protocol for 2009 providesunambiguous guidance for when two or moreprocedures are performed on the same pa-tient: a time out is performed to confirm eachsubsequent procedure before it is initiated.1

Additionally, safety can be enhanced when allteam members suspend activities and focustheir attention on confirmation of the correctpatient, correct site, and other critical elementswith the patient identifiers and consent.

The Joint Commission’s Universal Protocolis applicable to every perioperative setting (eg,

office-based facilities, ambulatory surgery cen-ters, dental/maxillofacial facilities, interven-tional radiology suites, endoscopy laborato-ries) where operative and other invasive pro-cedures are performed, including facilities notaccredited by the Joint Commission.

The 2009 NPSGs delineate other recommen-dations to reduce the risk of errors during inva-sive procedures. Health care organizations in allsettings should incorporate these recommenda-tions into policies and practice together withother risk-reduction strategies. Example include • an interactive, team communication approach

that eliminates complacency and rote execu-tion of the time out;

• briefing checklists that foster thorough inclu-sion of critical items that must be verified; and

• simulation training that hones the briefing pro -cess, aligns perceptions, and improves commu-nication skills while promoting a team culture.A wealth of tools and guidelines are available

for educating staff members and assisting withimplementation of policies to promote perioper-ative patient safety, regardless of the accreditingagency used by the organization. The WorldHealth Organization has published a practicalimplementation guide and one-page surgicalsafety checklist for implementing the time-out.2

The AORN Correct Site Surgery Tool Kit3 isavailable at no cost to members and can be usedto implement the Joint Commission’s UniversalProtocol. Successful patient outcomes can beachieved with deliberate education, knowledge,

http://www.cms.hhs.gov/PQRI/Downloads/PQRITaxReliefHealthCareAct.pdf. Accessed November24, 2008.2. ACS Quality Measures: Implementation Guide(Version 1.0). ASC Quality Collaboration. http://www.ascquality.org/documents/ASCQualityCollaborationImplementationGuide.pdf. AccessedNov ember 11, 2008.3. National voluntary consensus standards as ofOctober 29, 2008. National Quality Forum. http://www.qualityforum.org/pdf/Btblendorsedmeasurescurrent.xls. Accessed November 12, 2008.4. Stanton C. New tools to promote ASC quality.AORN Management Connections. April 2008. http://www.aorn.org/Managers/April2008Issue/NewToolsToPromoteASCQuality. Accessed November 11, 2008.

When to perform the surgical time out

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