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  • January 2013 Vol 29, No 1

    The monthly publication for OR decision makers

    Joint project targets prevention for colorectal surgical infections

    Safer surgery: Ten elements to help improve patient care and revenue

    Seven hospitals working with the Joint Commission and the American College of Sur- geons (ACS) on a 2-year project to reduce colorectal surgical site infections (SSIs) have saved more than $3.7 million by avoiding an estimated 135 SSIs, the commission announced in November 2012.

    The commission is pilot testing the approach used in the project with the aim of rolling out tar- geted solutions for all accredited hospitals in 2013.

    Joint Commis- sion President Mark Chassin, MD, FACP, said colorectal sur- gery was cho- sen as a focus because it ’s a

    common major surgery with a significant rate of complications, particularly SSIs. Also, complica- tion rates vary widely, suggesting

    For hospitals, quality and rev-enue are increasingly inter-twined. Performance on qual- ity measures like appropriate an- tibiotic administration, surgical site infection rates, and patient

    experience is being woven into reimburse- ment by Medi- care and pri- vate payers.

    Your hospi- tal likely will have some pay-

    ment at risk for not meeting and improving on quality measures. But it can also benefit from supe- rior performance.

    Better-performing health sys- tems can negotiate more favor-

    able rates from insurers and at- tract physicians, who also benefit from doing well on quality met- rics. That in turns attracts more patients, bringing more surgical volume and market share.

    It’s a shift for hospitals that are used to fee-for-service payment in which they perform a service, submit a claim, and expect to be paid.

    In this issue, OR Manager be- gins a series on page 8 titled Ten Elements of Safer Surgery, focus- ing on how your department can improve care for patients and in turn improve your business. The series is based in part on Safer- Surgery, an initiative of Advocate Health Care, a 10-hospital system in the Chicago area. ❖

    Patient safety

    Performance improvement

    Continued on page 6

    Inside OR Manager

    OR BUSINESS MANAGEMENT New workshop planned for OR business managers .....5

    PATIENT SAFETY Solid OR governance is the foundation for safety ........8

    PATIENT SAFETY Hospitals share data to prevent colorectal SSIs .......... 11

    OR BUSINESS MANAGEMENT Standardizing to control costs of spinal implants ..................14

    HUMAN RESOURCES Succession: Identifying and mentoring OR leaders ..........16

    GI ENDOSCOPY Scope storage: Don’t get hung up on a number ...........19

    OR BUSINESS MANAGEMENT A checkup for your OR’s value analysis process ..........21

    Quality reporting for ASCs is off to a good start ......................... 24

    Helping to avoid postdischarge nausea and vomiting ......................28

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  • No travel required. You don’t need to get on the plane, train, or bus.

    You can keep current on the latest information for managing the OR Suite with the OR Manager webinars without leaving your of� ce. Bring in your managers, educators, and other staff to hear these exciting speakers on topics relevant to what you do in the OR every day. It is a great way to provide educational opportunities for you and your staff. ■ Make your managers look forward to Thursdays.

    All webinars are at 2 pm eastern on Thursdays. ■ Invite your management staff to participate. For one

    registration fee, you get one set of handouts (you may make copies for other participants), one toll-free connection to the webinar, and one Internet connection to the webinar. Maybe someone will bring donuts.

    Continuing Education Credit Everyone who participates in the webinar earns contact hours. For one-hour webinars, you earn 1 contact hour.

    Miss a webinar? You can get the recording. You and your staff can access and listen to the recording for 30 days.

    Check out the complete listing of OR Manager webinars at


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  • 3OR Manager Vol 29, No 1January 2013


    Carol Brault • 301-354-1763 •


    EDITOR Pat Patterson • 303-756-0579 •

    CLINICAL EDITOR Judith M. Mathias, MA, RN



    SENIOR VP/GROUP PUBLISHER Jennifer Schwartz • 301-354-1702


    ART DIRECTOR David Whitcher

    SENIOR PRODUCTION mANAGER Joann M. Fato • 301-354-1681 •


    National Advertising Manager Ashley W. Kerwin

    Account Executive, OR Manager 301-354-1814 Fax: 301-340-7136


    Wright’s Media 877-652-5295 •

    Vol. 29, No. 1, January 2013 • OR Manager (ISSN 8756- 8047) is published monthly by Access Intelligence, LLC. Periodicals postage paid at Rockville, MD and additional post offices. POSTMASTER: Send address changes to OR Manager, 4 Choke Cherry Road, 2nd Floor, Rockville, MD 20850. Super subscription (includes electronic issue and weekly electronic bulletin) rates: $179 (plus $10 shipping for domestic and Canadian; $20 shipping for foreign). Single issues: $29. For subscription inquiries or change of address, contact Client Services, Tel: 888-707-5814, Fax: 301-309-3847. Copyright © 2013 by Access Intel- ligence, LLC. All rights reserved. No part of this publication may be reproduced without written permission.

    OR Manager is indexed in the Cumulative Index to Nursing and Allied Health Literature and MEDLINE/PubMed.


    Access Intelligence, LLC Chief Executive Officer

    Don Pazour Executive Vice President & Chief Financial Officer

    Ed Pinedo Exec. Vice President, Human Resources & Administration

    Macy L. Fecto Divisional President, Access Intelligence

    Heather Farley Senior Vice President, Chief Information Officer

    Robert Paciorek Senior VP, Corporate Audience Development

    Sylvia Sierra Vice President, Production and manufacturing

    Michael Kraus Vice President, Financial Planning and Internal Audit

    Steve Barber Vice President/Corporate Controller

    Gerald Stasko

    4 Choke Cherry Road, Second Floor Rockville, MD 20850 •

    When you read the dis-turbing reports linking nurses’ stress, burn- out, and workload to worse pa- tient outcomes, you wonder why staff and patient safety aren't ad- dressed together.

    In just one example, a study found a high rate of nurse burn- out was related with higher rates of catheter-associated urinary tract infection and surgical site infec- tion (Cimiotti J P, et al. Am J Infect Cont. 2012;40:486-490).

    A new report from the Joint Commission bridges the gap, tying together the twin objectives of making health care safer for pa- tients and workers alike.

    Too often, these efforts run on parallel tracks—the quality de- partment focuses on patient safety, occupational health addresses em- ployees, risk management deals with sentinel events, and so forth.

    The report urges that these silos be spanned and makes the case for why these programs should be seamless.

    Actually, there’s a lot of over- lap—a culture of safety for pa- tients won’t take root if the staff who provide care are neglected.

    The report brings together prin- ciples of high-reliability organi- zations, professional guidelines, health and safety regulations, and Joint Commission standards.

    Return on investment Case studies illustrate the return on investment and other benefits organizations have seen from these programs−better staff reten- tion, fewer sick days, higher pa- tient satisfaction, lower workers comp costs, and fewer lawsuits.

    One case study highlights how St Vincent’s Medical Cen- ter, Bridgeport, Connecticut, has made employee safety part of its high-reliability culture. Employee safety is defined similarly to pa- tient safety:

    • serious safety event: reaches the employee and results in lost work time

    • precursor safety event: reaches the employee, results in mini- mal harm or no detectable harm with no lost time

    • near miss event: does not reach the employee; error is caught by a barrier designed to detect and prevent the event. Data is tracked and trended on

    employee safety events, just as it would be for patients.

    St Vincent’s leaders have ad- opted practices that advance safety: • storytelling: sharing stories of

    harm that happened locally • daily huddles: briefings to re-

    view safety events and concerns housewide and at the unit level

    • senior leader rounding: lead- ers adopt departments to round with patients and employees on safety issues

    • safety coaches: staff serve as front-line coaches to promote safety among their peers. The report is a good re


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