HARRISBURG: Patients who required hospital-level care within hours or days after treatment at an ambulatory surgical facility (ASF) may have benefited from more detailed discharge instructions and more structured patient-provider communication, according to reports submitted to the Patient Safety Authority through its mandatory, statewide Pennsylvania Patient Safety Reporting System (PA-PSRS).
While it appears that most ASFs provide appropriate discharge instructions, reports to PA-PSRS from ASFs, highlighted in the December 2005 issue of the Patient Safety Advisory, identify opportunities for improvement. There are a number of strategies healthcare providers can take to improve their discharge protocols, including:
- Providing the patient or family members with well-defined, objective criteria for seeking follow-up care or physician contact.
- Discussing pain management expectations, trade-offs and alternatives with the patient.
- Addressing incisional bleeding, dressings and pressure dressings and clearly explaining to the patient or caregiver when to contact the physician for further intervention.
- Reviewing preoperative medications and postoperative resumption of medications, with special attention paid to anticoagulants.
- Reinforcing the risks related to specific instructions, such as driving within 24 hours postoperatively or lacking a supportive caregiver.
- Developing a comprehensive discharge checklist.
Alan B. K. Rabinowitz, administrator of the Patient Safety Authority, said while post-operative admissions to a hospital are rare following a procedure in an ASF, quality patient care should always be a healthcare facility’s number one goal.
“Because in today’s environment so many procedures are performed in free-standing ambulatory centers, it’s important to recognize the kinds of adverse events that can occur in those settings,” Rabinowitz said. “It’s the role of the Patient Safety Authority to identify actual or potential patient safety issues, but it’s the responsibility of
individual facilities to implement steps to assure quality patient care.”
Rabinowitz noted that patients also have a responsibility to assure good outcomes.
“Because patients undergo a procedure and are discharged from an ASF the same day, patients and their families must play a vital role in monitoring their own recovery. That’s why the quality of discharge instructions is so important.”
In addition to this article, entitled “Unanticipated Care after Discharge from Ambulatory Surgical Facilities,” other articles in the December 2005 Patient Safety Advisory include:
For a copy of the December 2005 Patient Safety Advisory, click here.
BACKGROUND
The Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act, to help reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety. Under the Act, all Pennsylvania-licensed hospitals, birthing centers and ambulatory surgical facilities are required to report what the Act defines as “serious events” and “incidents” to the Authority. More than 445 healthcare facilities are subject to Act 13 reporting requirements.
Facilities submit reports of serious events and incidents through the Pennsylvania Patient Safety Reporting System (PA-PSRS), a confidential web-based system that was developed for the Authority under a contract with ECRI, a Pennsylvania-based independent, non-profit health services research agency, in partnership with EDS, a leading international, information technology firm, and the Institute for Safe Medication Practices (ISMP), also a Pennsylvania-based, non-profit health research organization.
More than 240,000 reports have been submitted through PA-PSRS since the program was initiated in June 2004. Ninety-five percent of these reports are Incidents or “near-misses.” Based on those reports, the Authority issues quarterly Patient Safety Advisories to advise hospitals and other healthcare facilities about steps they can take to reduce and prevent patient harm. Occasionally, if reports are submitted that demand immediate attention, a Supplementary Advisory focusing on that one particular topic will be issued.
For more information on the Patient Safety Authority, PA-PSRS or previous Patient Safety Advisories, visit the Authority’s website at www.patientsafetyauthority.org.
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