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Lax Practices Found at Same-Day Surgery Centers

Monday, June 28, 2010 @ 01:06 PM Karen Hood

Excerpted from, “Lax Practices Found at Same-Day Surgery Centers” The New York Times. June 8, 2010–A new federal study finds many same-day surgery centers have serious problems with infection control. Failures to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. The findings, appearing in Wednesday’s Journal of the American Medical Association, suggest that lax anti-infection practices may pervade the nation’s more-than-5,000 outpatient centers, experts said. In the study, state inspectors visited 68 centers in Maryland, North Carolina and Oklahoma. The study found that 67 percent of the centers, which perform such procedures as colonoscopies and esophagus examinations, had at least one lapse in infection control and that 57 percent were cited for deficiencies. Inspections were not announced ahead of time, but staff members were notified w! hen inspectors arrived. The study did not look at whether any of the lapses actually led to infections in patients.

CMDA Member Mark McQuain, MD: “Years ago I attended a presentation, a pilot program by an insurance company to show off a new tool called ‘Utilization Review’. The UR resulted in altering the doctor’s treatment plan 27% of the time. I asked whether there was a benefit to the patient due to that alteration. I was informed that outcome data was not collected.
This JAMA study reviewed a CMS pilot program of an infection control audit tool designed to assess Ambulatory Surgery Centers (ASC) infection control. This previously untested tool identified an increased number of ‘lapses’ in ASC infection control compared to previous surveys. CMS has subsequently incorporated this tool into its ‘Interpretive Guidelines for Ambulatory Surgical Centers’. However, the JAMA article correctly points out several problems with interpreting the pilot study. The most concerning was that data related to outcomes or numbers of actual hospital acquired infections linked to the ‘lapses’ was not collected. The tool appears to be a more sensitive collector of data but the data collected is potentially ambiguous.
It should go without saying that physicians and nurses want to provide the very best medical care for their patients. Developing and following policies that actually ensure reduced infection rates can help to provide that level of excellent care. But policies are tools and not ends in themselves. We need to make sure that any assessment of our practice of medicine always includes some measure of the actual medical care provided and not just a measure of the policies that assist in delivering that care.”

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