On-site Clinical Risk Comprehensive Assessment: Surgical Services

Efforts to improve surgical care represent an important opportunity for performance measurement and reporting in healthcare. Approximately 42 million surgical procedures are performed annually in the United States, and as many as 40 percent of them result in surgical complications. One study found that postoperative complications resulted in up to 22 percent of preventable deaths among patients, depending on the complication. Increased workload and competing tasks pose the greatest threats to patient safety in the operating room.

Historically, surgical complications were thought to be unavoidable —an accepted risk of the practice. The lack of effective systemization makes it difficult for healthcare professionals to consistently provide the highest levels of care in the surgical and post-surgical arena. In an effort to provide an integrated, systematic, and standardized approach to reduce surgical complications, Clinical Risk Solutions, Inc. provides on-site comprehensive clinical risk assessments--a proven methodology to achieve a patient safety-centered model of excellence.

Following a pre-assessment telephonic leadership interview, a two-day, on-site assessment is conducted. A prioritized plan of improvement, resource tool kit, and educational sessions are included within the scope of the initiative.

The Surgical Services on-site assessment includes a review of the following areas:

• Physician profile, department leadership, committee structure, patient safety culture, documentation, and communication
• Surgical services administrative structure
• Nursing profile, licensing, orientation, competency validation, and ongoing education
• Patient safety culture, adverse event management, and quality initiatives
• Medical staff credentialing, peer review, and performance evaluation
• Preoperative, operative, postoperative, and discharge of the surgical patient
• Medical record clinical documentation
• Select policy review—informed consent, Universal Protocol, sponge count, medical error management, medical staff disruptive behavior, blood administration, and needle count
• OR interface with: Diagnostic Imaging, Laboratory, ED, OB, and ICU
• Clinical practices, policies, and procedures
• Structured communication handoff process
• Adverse event management process, data analysis, professional liability claims review
• Quality/patient safety initiatives
• Medication safety management, pharmacy interface, and regulatory oversight
• Medical equipment management
• Environment of Care standard compliance
• Infection control program
• Security management
• Written comprehensive report with a prioritized plan of improvement
• Tool kit of resource materials