Is Your Facility Disaster-Ready?

Remember the breakdown in patient care that followed Hurricane Katrina and Hurricane Sandy? A new CMS rule is aimed at preventing a recurrence. As part of its Emergency Preparedness Rule, CMS insists that you prove that you're ready to deal with such natural and man-made disasters as hurricanes, pandemics and terrorist attacks. Hospitals, surgery centers and all other healthcare facilities have a little more than a year to meet new federal disaster preparedness requirements as a condition of participation in Medicare and Medicaid.

For example, you must have emergency plans and training for personnel — and run emergency drills twice a year to test these plans and programs, "so that all are better positioned to work together to protect health in the face of a disaster," says Nicole Lurie, MD, MSPH, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services. You must also have a communication plan in place to coordinate with your patients as appropriate, as well as with public health officials, emergency management officials, and other health care providers within the city, county and state, adds Dr. Lurie.

The rule lists 4 core elements to achieve compliance:

  • risk assessment and emergency planning
  • policies and procedures
  • communication plan
  • training and testing

There is a fifth requirement for emergency fuel and generator testing that applies only to hospitals. "But if a facility has an emergency power capability, it would certainly be better to exceed compliance requirements, regardless of your type of facility, then not," says Spence Byrum, CEO of HRS Consulting.

"The 4 elements articulated by CMS are not new and should not be considered overly onerous and or intrusive," says Mr. Byrum. "They are the very things for which we should be prepared to be able to adequately care for our patients and professionals should the worst happen. We have seen numerous examples of highly regarded, well-run institutions fail when it counted the most, with hurricanes, floods, Ebola patients, etc. The risks actually seem to be increasing, with discontent, radicalism and firearms increasingly in the news."

Visit here for sample plans, tools, templates, and training and exercise materials.

CMS issued this new rule to create a consistent foundation of emergency preparedness across the health care system, ensuring that providers across the spectrum are better positioned to respond to disasters and to ensure continuity of care for some of our most at-risk populations, says Dr. Lurie.

Under the final rule, ambulatory surgical centers will be required to meet most of the same proposed emergency preparedness requirements as those proposed for hospitals, with 2 exceptions: ASCs will not have to provide information regarding their occupancy, or provide for subsistence needs of their patients and staff.

Dan O'Connor

Anesthesia Moving Out of ORs

Don't look now, but a growing number of minimally invasive procedures and tests that require anesthesia are moving out of the traditional OR setting. Research presented at this week's annual meeting of the American Society of Anesthesiologists says roughly one-third of 18 million cases involving anesthesia performed between 2010 and 2014 took place outside the OR, an increase of 27% over the 5-year period.

Colonoscopy was the most commonly performed procedure requiring anesthesia that took place outside of the OR.

Anesthesiologist Richard Dutton, MD, senior author of the study and chief quality officer at U.S. Anesthesia Partners in Dallas, Texas, says providers working in the healthcare trenches are aware that low-risk cases are moving out of the OR, but he wanted to tap into big data from the Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry (NACOR) to quantify the shift for his colleagues at the societal level. "We're no longer just a hospital-based specialty that only administers general anesthesia during operations involving big incisions," he explains.

Dr. Dutton says anesthesiologists are enabling a "mega trend" of physicians caring for sicker patients during more involved gastroenterology procedures such as ERCPs, invasive radiologic cases and endovascular stenting performed outside of the traditional OR setting. Anesthesiologists still need to be present to ensure the safe delivery of minimal to deep IV sedation or regional anesthesia to older patients who present with heart disease, stroke, severe liver disease or other comorbidities, according to Dr. Dutton.

He points out the movement of traditionally complex procedures to less invasive clinical environments is the natural progression of science and medicine. The business of OR-based care is far from dead, says Dr. Dutton, but "anesthesiologists are helping to move cases to more appropriate clinical settings. That's who we are now."

Daniel Cook

Does Gastric Bypass Invite C. Diff. Infections?

Patients who have Roux-en-Y gastric bypass surgery appear to be more vulnerable to Clostridium difficile infections than patients undergoing other kinds of abdominal surgery, a new study finds, possibly because they secrete less stomach acid after the surgery and thereby create a more favorable environment for the infection.

The findings were reported by Emmanuel Ugbarugba, MBBS, at the American College of Gastrenterology annual meeting in Las Vegas.

In a nationwide study, Roux-en-Y patients were found to be substantially more likely to be readmitted with C. diff infections in the 31-120 days after discharge than patients undergoing either vertical sleeve gastrectomy or ventral hernia repair.

Noting that multiple factors could be involved, Dr. Ugbarugba suggests that more testing is needed to determine whether the increased incidence is in fact related to decreased stomach acid.

Jim Burger

InstaPoll: When's the Last Time You Applied for a Job?

Are you job hunting? Is your resume up to date? Tell us in this week's InstaPoll.

Eighty-one percent of the 252 readers who responded to last week's poll say it's difficult to find the right candidates for staff openings. The results:

How easy is it to fill staff openings?

  • very easy 2%
  • somewhat easy 12%
  • easy 5%
  • somewhat difficult 48%
  • very difficult 33%

Dan O'Connor

News & Notes

  • Push to require antibiotic-resistant reporting A California State Senator will introduce legislation in December that would require hospitals in the state to report all cases involving patients who develop antibiotic-resistant infections.
  • Outpatient shoulder replacement deemed safe Outpatient shoulder replacement surgery is safe, suggests 2005-2014 data from the American College of Surgeons National Surgical Quality Improvement Program, which shows a 2.3% rate of adverse events and a 1.7% rate of readmissions, versus 7.9% and 2.9% for inpatient shoulder replacement.
  • Can nose cells repair knees? Grafts made of cells harvested from the nasal septum have the potential to heal damaged articular knee cartilage and improve joint pain and function, according to a team of Swiss researchers. Two years after implantation, the tissue grafts showed similar composition to the body's original cartilage, according to the researchers, who say the experimental procedure shows promise, but further research is needed before it can be considered for FDA approval.