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Outpatient Surgery E-Weekly

OR Excellence Pre-Registration Ends Wednesday

This Wednesday, Sept. 1, is your last chance to participate in Outpatient Surgery Magazine's OR Excellence 2010 Pre-Registration Contest. There's no...

Researchers Predict Anesthesiologist Shortage, CRNA Surplus

A recent analysis of the anesthesia labor market speculates that a current shortfall of providers across the surgical industry could widen in the ne...

A Change of Mind: Anesthesia, Consciousness and the Brain

The brain works through different processes as it transitions between conscious and unconscious states, a finding that bucks commonly held assumptio...

Outpatient Surgery E-Weekly February 9th, 2010

THIS WEEK'S ARTICLES

Safety Violations Close Florida Endo Center
Ergonomic Complaints Common Among Laparoscopic Surgeons
Nevada Hepatitis Lawyers Cite Drug Maker
InstaPoll: What Do Surgeons Complain About Most?

NEWS & NOTES

Tip of the week
More time for SS1 shift
California sued over CRNAs
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LAST WEEK'S E-WEEKLY ARTICLES

New Superbug From India May Go Global
The Case for Admitting Medical Errors
New Implant Coating Prolongs Joint Replacements
InstaPoll: Where Would You Go for Surgery?
News & Notes
Safety Violations Close Florida Endo Center

The Florida Agency for Health Care Administration has prohibited the Fort Myers Endoscopy Center from treating patients after 19 regulatory violations were discovered during a recent inspection.

The infractions were discovered during a Jan. 19 recertification and license survey.

The center has until Feb. 13 to comply with the citations or risk losing its Medicare certification and its state license. Some of the violations cited in the 17-page inspection report include:

  • medication safety infractions, including lack of or erroneous labeling and expired medications on the premises;

  • medical equipment, such as cardiac monitor and defibrillator, that hadn't been inspected since 2008;

  • emergency generator that hadn't been properly maintained;

  • no notification of patients' rights;

  • improperly trained staff;

  • use of unsupervised nurse anesthetist for procedures; and*

  • lack of a circulating registered nurse during 6 procedures.

    A spokeswoman for the state agency says the facility has submitted a plan for dealing with the state regulatory infractions, but not the federal violations.

    The facility declined to comment when reached by phone, but Nursing Director Beverly Marsland told the Fort Myers News-Press that they'd submitted a corrective plan to CMS on Feb. 4. "We've been working on it and just going down the checklist and taking care of all the paperwork that they need," says Ms. Marsland, adding that the facility plans "to get back to seeing patients at the center as soon as possible."

    *CLARIFICATION: According to the state's inspection report, review of the facility's credentialing files of its practicing physician revealed that "there was no documentation found of the physician's qualifications to administer or supervise the administration of anesthesia," nor was there any documentation of specialized training he received to oversee or supervise the administration of anesthesia by the CRNA. Inspectors also found no documentation that the CRNA had been granted clinical privileges by the facility's governing body.

    Irene Tsikitas

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    August 17th E-WEEKLY

    Splitting the Dose Improves Bowel Prep Results
    First U.S. Natural Orifice Stomach Reduction
    Protein May Aid In Joint Repair
    InstaPoll: Have You Ever Used a Single-Dose Vial More Than Once?
    News & Notes
    Ergonomic Complaints Common Among Laparoscopic Surgeons

    Laparoscopic surgeons often stand in awkward positions as they maneuver their instruments through fixed ports for long stretches, making them prime candidates for work-related injuries, according to a recent survey conducted by researchers at the University of Maryland School of Medicine in Baltimore.

    Out of 317 board-certified gastrointestinal and endoscopic surgeons surveyed, 272 (87%) report that they've experienced discomfort during surgery, including eye strain, neck, back and leg pain, headaches, finger calluses, disc issues, muscle spasms and carpel tunnel syndrome.

    While 84% of the respondents say they've changed positions during surgery and 30% swap instruments in attempts to avoid aches and pains, 40% have ignored ergonomic issues. More than half were unaware of the recommendations made by surgical ergonomic experts, according to the survey, which will appear in the March issue of the Journal of the American College of Surgeons.

    David B. Renton, MD, MPH, an assistant professor of surgery at Ohio State University in Columbus, says he knows surgeons who have had tendon problems in their hands due to the instruments they use, which was a major complaint of 74% of the surgeons involved in the survey. It doesn't have to be this way, says Dr. Renton. "We keep squeezing an instrument tightly to hold a piece of tissue in retraction, even though the instrument locks and holds it if we just squeeze lightly."

    The survey's lead author, Adrian E. Park, MD, chief of general surgery at the University of Maryland Medical Center and professor of surgery and vice chair of the school's department of surgery, says surgeon injuries need to addressed before healthcare experiences "a shortage of surgeons as well as shortened career longevity among surgeons who enter, or are already in, the field."

    Daniel Cook

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    August 10th E-WEEKLY

    How Have You Managed Patient Safety Scenarios?
    Pre-Screening for Staph Reduces Ortho SSIs
    FDA Proposes Stricter Standards for Device Approval
    InstaPoll: When Do You Use Surgical Glue?
    News & Notes
    Nevada Hepatitis Lawyers Cite Drug Maker

    Were a drug maker's packaging and instructions partially to blame for the hepatitis C outbreak that emerged from Nevada endoscopy centers between 2004 and 2008? Lawyers for some exposed patients plan to make that case at trial.

    Las Vegas attorneys Will Kemp and Robert Cottle argue that a statement made by an executive at Irvine, Calif.-based Teva Parenteral Medicines, a division of Teva Pharmaceutical Industries and the manufacturer of the propofol used at the now-closed Endoscopy Center of Southern Nevada, implies that the company shares some of the liability for the center's unsafe injection practices.

    In a deposition given in May 2009 and recently made available, they say, Vice President of Marketing Craig Lea noted that while a veterinary version of the drug included instructions to draw a vial's entire contents into a single sterile syringe, the human propofol did not.

    Compounded with the company's discontinuation of 10-milliliter vials of the drug - a suitable amount for the average endoscopy case - in favor of 20- and 50-milliliter vials, as well as the center staff's aversion to wasting drugs, the single-use vials encouraged reuse.

    The civil trial against the endoscopy center, which may have exposed 63,000 patients to hepatitis C, is scheduled to begin in April.

    David Bernard

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    August 3rd E-WEEKLY

    Virtual Colonoscopy Lacks Cost Effectiveness, Say Researchers
    Study Touts Smaller, Rural Hospitals' Safety
    1 in 5 Joint Replacement Patients Lose Weight
    InstaPoll: When Do You Test Your Reprocessing Agent?
    News & Notes
    InstaPoll: What Do Surgeons Complain About Most?

    Your surgeons are probably pretty content with how your facility is run. But if you had to identify the one aspect that's most underwhelming to them, what would it be? Scheduling? The anesthesia team? Your staff's know-how? The equipment? The lounge? Parking? Tell us in this week's InstaPoll. We'll report the results in this space next week.

    Last week, nearly two-thirds (64%) of the 85 respondents to our online poll said they'd been victims of sexual harassment during their healthcare careers.

    Dan O'Connor

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    July 27th E-WEEKLY

    N.Y. Hepatitis Outbreaks Linked to Propofol Reuse
    Cost Could Deter Patients From Colon Screenings
    Athletes Benefit From Arthroscopic Hip Surgery
    InstaPoll: Do You Check Your Work E-Mail on Vacation?
    News & Notes
    News & Notes
  • Tip of the week Your ASC may not have the staffing resources of a hospital, but it might be able to offer better continuity of care. "Whenever it's possible, we assign one nurse to follow through an entire case: calling the patient back to pre-op, circulating in the OR and monitoring his recovery," writes Dick Farr, OPA-C, CASC. "The patient gets to see the same smiling face all the way through his visit. Compare that with having a procedure done in a hospital, where you're constantly shifted from one face to another and you can't remember the name of anyone who provided care."

  • More time for SS1 shift The FDA is giving healthcare facilities 18 more months to discontinue use of the Steris System 1 tabletop liquid chemical reprocessor and transition to a legally marketed alternative device. The agency says it extended the recommended time period for replacing the SS1 after healthcare providers and professional organizations warned that the original 3- to 6-month transition period would be difficult for facilities to attain and therefore could "adversely affect patient care."

  • California sued over CRNAs Two physicians groups are suing California Gov. Arnold Schwarzenegger, claiming that he violated state law when he authorized nurse anesthetists to administer anesthesia unsupervised. The Schwarzenegger administration disputes the allegations by the California Medical Association and California Society of Anesthesiologists, which argue that he failed to consult with the state nursing and medical boards and ignored existing state laws when he opted out of the federal rule requiring physician supervision of CRNAs last year. The groups want the court to force the governor to withdraw his opt-out letter from CMS and "take no further action to effect an opt-out."
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    July 20th E-WEEKLY

    Physicians Reluctant to Tattle On Their Own
    Study Uncertain on Most Effective Fix for Rotator Cuffs
    Good News for ASCs Performing Office-Based Services
    InstaPoll: How Do You Keep Fluid Off the Floor?
    News & Notes