The Importance of Patient Selection at Out-Patient Ambulatory Centers

POSTER

The Importance of Patient Selection at Out-patient Ambulatory Centers Greg Sanders, CRNA, MSN, DNP student PURPOSE RESULTS METHODS To improve safety and operational effectiveness by determining which patients are appropriate for a procedure at an outpatient surgery and/or endoscopy facility or if the patient should be referred to a hospital in order to decrease morbidity and mortality, and minimize last minute cancellations METHODS 1. Construct a questionnaire regarding current prescreening processes 2. Contact 10 surgery/endoscopy centers using questionnaire to determine a community standard 3. Compare results gathered from these centers with current trends from literature 4. Develop an evidence-based patient exclusion screening protocol for a stand-alone outpatient endoscopy clinic 5. Present the screening protocol for potential use at local endoscopy center and further dissemination to the AANA and its members 1. Every facility had a different variation of prescreening method 2. Most of the centers focused on similar comorbidities to exclude, but the cutoff ranges had variation 3. The literature review emphasized the importance of prescreening for ambulatory surgery or procedures, but wasn’t as focused on absolute cutoff parameters CONCLUSIONS BACKGROUND In the United States, there has been a shift in outpatient procedures being performed in hospitals, to more of them being done at outpatient surgery centers Last minute cancellations at outpatient surgery centers contribute to millions of dollars of unnecessary healthcare expenses and may add increased risk to patient’s safety There are times when the anesthesia provider and the doctor may not agree whether a patient should be seen at an outpatient center due to their comorbidities Variations among outpatient surgery/endoscopy centers and current literature were: 1.Age 2.ASA classification 3.COPD and oxygen use 4.History of TIA or stroke 5.Morbid Obesity 6.Obstructive sleep apnea (OSA) 7.Previous heart stent or surgery Ambulatory Prescreening Recommendations AGE <85, ok to proceed >85, evaluate comorbidities ASA CLASS BMI ASA I,II,III-Ok to proceed ASA >4,schedule at hospital <50, minimal comorbidities-ok to proceed >50, schedule at hospital Cardiac Pacemaker, heart attack, stroke, stent placement >3 months-ok to proceed Defibrillator, heart attack, stroke, stent placement <3 months- schedule at hospital Renal ESRD undergoing regular hemodialysisok to proceed ESRD not undergoing regular hemodialysis- schedule at hospital Respiratory Controlled asthma, COPD, obstructive sleep apnea- ok to proceed The number of outpatient surgery/endoscopy centers have increased significantly over the last twenty years Comorbidities of patients being seen at these centers are increasing The guidelines currently available are subject to professional interpretation and multiple variations Using current literature and 10 outpatient surgery/endoscopy centers, a standardized prescreening tool was constructed to rule out high-risk patients at ambulatory centers to help minimize last-minute cancelations and decrease morbidity and mortality Uncontrolled asthma, COPD (on oxygen), obstructive sleep apnea- consider scheduling at hospital Committee Members: Project Chair- Clint Child DNP, MBA, RN; Program Director- Gillian Tufts DNP, MBA, RN; Assistant Dean for MS & DNP- Pamela Hardin PhD, RN, CNE; Content Expert- Bruce Carter, MD.