Jan 12, 2018 in Research

Contingency Planning in Outpatient Surgical Center

An outpatient surgery center is a freestanding center that provides planned elective, outpatient surgical procedures, allowing a patient to recover and leave the center in most cases during the same day of surgery. The outpatient surgery center itself contains several operating rooms complete with high-tech surgical equipment (Griffin & Polly, 2009). The advantages of an outpatient surgery center are much lower cost and the convenience of a much quicker recovery. Goldsmith & Goldfield (1995) indicated that health care providers are faced with ill-defined set of circumstances for delivering care and planning outpatient surgery programs. Contingency plans will ensure that all equipments required are available and prepare the patient for possible outcomes and altered plans for recovery (Ginter, 2013).

Patients who undergo outpatient surgery have a lower risk for complications and for sustaining unusual reactions as a result of favorable pre-selection. Out patient surgical procedures are carried out for a healthier cohort of patients who are less likely to encounter complications than inpatients (Goldsmith & Goldfield, 1995). Effective strategic planning in outpatient surgical center depends on the quality of information available for formulating plans. Goldsmith & Goldfield (1995) noted that outpatient surgery is certain to play an important role in the strategy of most health care providers. Contingency planning is fundamental in outpatient surgical centers so as to minimize the impact of newly discovered weakness or threats that may arise from the formal plans. A contingency plan is therefore an alternative plan that can be put into effect if certain events do not occur as expected in the outpatient surgical center (Goldsmith & Goldfield, 1995).   

The strategic management of outpatient surgical centers has become more complex as the economic pressure shaping the industry has changed. While formulating contingency plans it is important to note that it is no longer possible to drift along without an idea of where the center is headed (Goldsmith & Goldfield, 1995). The contingency plan formulated below will enable the outpatient surgical center to respond quickly to changes in the internal and external bases of the center’s current strategy (Rao & Sivaramakrishna, 2009).

The first step is to spot both favorable and unfavorable events that could possibly derail the strategy. Favorable events mean pursuit of outpatient surgery may represent a fiscal, quality of care and service delivery constraint evolving into an organization threatening concern. Goldsmith & Goldfield (1995) says that unfavorable events involve providers; failure to take strategic initiative in building strong outpatient surgery programs which in turn result into competitive advantage.  For example initial steps in the operating room must always include preparation of drugs and equipment for life support, the means for supplementation and provision of contingency plan.   

The second step is to identify trigger points that is when contingent events are likely to occur. Trigger points may occur as surgeons attempt more complex procedures in outpatient settings.  It is difficulty to administer an efficacious anesthetic that also permits minimal complications. This places pressure on physicians so as to avoid postoperative dysfunctions (Goldsmith & Goldfield, 1995). A patient’s emotional and psychiatric needs are as important as physical status in assessing preoperative risk and postoperative outcome. Physical status and the capacity of the patient to withstand the stress of the surgical procedure must be determined. It is important to note that in relation to the type of surgery, the anticipated amount of narcotic required postoperatively managing pain, and the patient’s condition, outpatient surgery may not be wise (Griffin & Polly, 2009).   

The third step in contingency planning involves assessing impact of each contingent event that is estimate potential benefit or harm of each event. In outpatient surgery settings, subsequent reactions to anesthesia are less amenable to control because patients leave the premises. Goldsmith & Goldfield (1995) says that although stringent controls over discharges can reduce contingent events from outpatient surgery, time constraints ultimately test the limits of judicious patient care management.  

The fourth step is to develop contingent plans. It is important to ensure that the contingency plans are compatible with the current strategies of the center and that they are economically feasible. Ginter (2013) says that contingency plans are normally tied to key issues or events occurring or not occurring in the outpatient surgical center. The contingency plan should indicate the presence of risk factors related primarily to the person’s general state of health and to the specific disease symptom that could lead to physical injury within the center. Goldsmith & Goldfield (1995) says that the development of contingency plan should raise quality because of linkages with quality assurance and utilization review programs, high access to consultation and referral.

The fifth step in contingency planning involves assessing the counter impact of each contingency plan. According to Ginter (2013), it is important to estimate how much each contingency plan will capitalize on or cancel out its associated contingent event.  This will further quantify the potential value of each contingency plan. This step will determine presence of risk factors inherent in the outpatient surgery that endanger the health and safety of the patient (Swansburg, 2010).  This will establish if or not appropriate preventive measures are instituted and maintained and if ongoing observations and monitoring are instituted in the center.

The sixth step is to determine early warning signals for key contingent events and to monitor them. Griffin & Polly (2009) says that early warning signs will ensure that the center supplies reliable emergency power to alarm systems, exit sign and exit route illuminations and emergency communication systems. The center should come up with a selection process for cases and patient that create a predictable environment (Griffin & Polly, 2009). Enough attention to wellbeing which surpasses that used in the basic care facilities should be provided besides giving redundant support systems. Swansburg (2010) says that appropriate complications contingency planning might include the availability of on call anesthesia and vascular surgery expertise as well as intensive care staff and equipment.    

The last step is to ascertain that for contingent events with reliable early warning signals, develop advance action plans to take advantage of the available lead time. This step involves careful monitoring of patient outcomes and the literature to discover the best practices to consistently leave postoperative patients clear headed and as free of nausea and pain as possible (Swansburg, 2010). Another important action plan is to ensure that the practitioners in outpatient centers are more highly trained and practiced in a wider variety of skills sets because there are few redundant systems in these centers. Swansburg (2010) says that nurses in outpatient surgical centers need efficient nursing support systems, communication, distribution, transportation and unit management. This step revolves around the contingency that primary nursing is more effective when support systems are efficient and patient’s dependence on nurses is high.

The importance of the seven contingency planning steps can not be overlooked in a typical outpatient surgical center. Griffin & Polly (2009) indicated that this is on the basis that many surgeries that are not complicated and do not require serious nursing care are performed in an outpatient surgical center. Contingency planning ensures that the complex association between perceived plans, benefit and the acceptance of that plans is influenced by characteristics such as familiarity, control and level of knowledge (Griffin & Polly, 2009).

In conclusion, outpatient surgery centers have multiplied in the last ten years as a result of increasing hospital costs. Countless procedures may be performed safely in these centers at great convenience to the patient and at great saving to the health care system. Many centers specialize in a few procedures thus further decreasing costs and the time spent in the operating theater. Nowadays, contingency plans entail extra steps taken to provide staff, equipment and beds to allow patients to stay safely overnight in the outpatient surgery center for further monitoring and evaluation.

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