In this episode of the Advancing Surgical Care Podcast, ASCA Chief Executive Officer Bill Prentice talks with Mary Ryan, RN, BSN, MBA, CASC, CAIP, a senior consultant with Amblitel, about both the regulatory and practical considerations of preparing ASCs for emergency situations ranging from pandemics to natural disasters. This timely conversation took place at the ASCA 2022 Conference & Expo in Dallas, Texas, following a session about emergency preparedness Ryan presented there.
Welcome to the Advancing Surgical Care Podcast brought to you by ASCA, the Ambulatory Surgery Center Association. ASCA represents the interests of outpatient surgery centers of every specialty and provides advocacy and resources to assist them in delivering safe, high-quality, cost-effective patient care. As with all of ASCA’s communications, please check to make sure you are listening to or viewing our most up-to-date podcasts and announcements.
Bill Prentice: 0:37
Hello, and welcome to the Advancing Surgical Care Podcast brought to you by the Ambulatory Surgery Center Association, or ASCA. My name is Bill Prentice, I’m ASCA’s CEO and the host of this episode. My guest today is Mary Ryan. Mary learned to scrub while in nursing school at the University of Iowa and has remained in the perioperative field ever since. Early in her nursing career, she was appointed the director of nursing role for a startup surgery center and accepted the administrator position in 2001. Mary has held several management positions within the industry assisting in the startup of ambulatory surgery centers. As a group clinical director for Surgical Care Affiliates, Mary was responsible for the clinical results of 18 centers. She was also one of the founding members of the Iowa ASC Association and served as the organization’s first president. Mary is joining me for this podcast at ASCA’s conference and expo in Dallas, Texas, where she recently gave a presentation on emergency preparedness for ASCs, which is obviously a very timely topic given the advances of the past couple of years. Mary, welcome to the Advancing Surgical Care Podcast.
Mary Ryan: 1:38
Thank you very much. It’s my pleasure to be here and to be here in person is extra exciting for all of us.
Bill Prentice: 1:44
It’s awesome. That’s great to hear. Well, Mary, as I mentioned a moment ago, it seems like we’ve been living with the regular and frequent occurrence of natural disasters and pandemics for over a decade now. And there doesn’t appear to be any letup in sight. Emergency preparedness for ambulatory surgery centers is no longer an academic exercise. So, let’s talk about what’s required of ASCs today in terms of their planning or readiness for emergencies. Can you briefly tell us what CMS and the accrediting bodies are requiring?
Mary Ryan: 2:16
Absolutely, Bill. So first and foremost, all ambulatory surgery centers must have a documented emergency preparedness plan as it relates to our current environment and COVID and the pandemic. The emergency plan was actually most recently updated about a year ago to help us incorporate some of the things and the lessons that we’ve learned and some of the documents that we must have, as it relates to the pandemic and COVID-19. You can access those interpretive guidelines by downloading the State Operations Manual, Appendix Z—it’s titled Emergency Preparedness for All Providers and Certified Supplier Types. I highly recommend getting your hands on a copy of that and run through it. I’m just going to talk about some of the guidelines as it relates to the pandemic, but there’s a plethora of other guidelines that we must meet and that we’ve been having to meet for a few years.
Bill Prentice: 3:09
Mary Ryan: 3:10
So, I would categorize probably the main new requirements into four buckets: risk assessment and planning, policies and procedures, communication and, lastly, training and testing. Can I go into a little bit of detail about each one of those?
Bill Prentice: 3:25
That would be awesome. I think our listeners would really appreciate that.
Mary Ryan: 3:28
Okay, perfect. So, each center needs to be completing a hazard vulnerability analysis with all of the updates. We are now required to include emerging infectious diseases. The infection control risk assessment that we also have will need to be updated at least annually and must include now information on COVID-19 and what actions and processes that you have put into place to help mitigate that risk. Secondly, the pandemic drove a plethora of changes in our policies and procedures. I mean, how many reiterations of a policy have many of us gone through in the last couple of years? Some of the things that we’ve had to address in those policies are screening of patients, employees, medical staff and vendors, appropriate use of PPE and, in some times, what did we do at times where we had to reuse things that weren’t normally a reuse item. We also had to address a respiratory protection plan that none of us probably really had in very great detail prior to our most recent experience. And then lastly, employee health vaccination requirements as well as several environment of care changes. These policies must reflect our current practices and requirements from our state, local and federal agencies. Communication pathways—they really need to be established for how we connect with our staff, our patients, our visitors and our medical staff. Many implemented texting, patient portals, sites where staff can access information when they’re not physically in the facility. For training and testing, we must ensure that everyone is in the know related to policies, procedures and protocols. This also includes performing annual drills to identify gaps and put proper actions into place prior to an actual event.
Bill Prentice: 5:23
Well, that is a lot, Mary, and I’m sure our listeners are regretting not being here in Dallas to come to your session and hear in greater detail about all those four different buckets. But obviously, that’s one of the reasons why ASCA puts on webinars ensuring training throughout the year so that we can keep people up to date on things like this that are so really incredibly important. And I’m going to ask you a question that kind of touches back on some of the things you said, but maybe in a little different angle. More than a hundred years ago, Robert Burns penned a poem that warned us that even the best laid plans of mice and men will often go wrong. So, for ASCs, there are controllable events, and then other events that are totally beyond anyone’s control or knowledge. Can you help our listeners understand what it means in practical terms to prepare for a staffing shortage or a loss of communication services during a public emergency? Are there actual systems that can help or is it more just preparing our mindset for these challenges?
Mary Ryan: 6:23
Yes. So, your emergency staffing plans should include processes such as preparing for increased presurgical testing, as we’ve experienced in the past couple of years, perhaps increased absentee rates based on teammates being ill or the possibility of being exposed as well as potential work restrictions. So, it’s really about creating contingency plans. So, for instance, develop a plan to continue providing services if they’re appropriate, while still delivering safe, high-quality care. So, this could be accomplished by maybe closing one of your operating rooms but extending the hours that you operate in another one.
Bill Prentice: 7:02
Mary Ryan: 7:03
So, just by being creative, proactive and nimble, you really become more resilient, and after all, that’s really what ASCs are known for, aren’t we?
Bill Prentice: 7:13
It certainly is. Well, listen, Mary, before we continue, I’m going to ask that we take a short pause to hear a quick word from our podcast sponsor. We’ll be right back.
This episode of the Advancing Surgical Care Podcast is being brought to you by National Medical Billing Services, an ASCA affiliate and leading ASC revenue cycle company that helps ASCs properly capture their revenue and maximize their cash flow in a highly compliant fashion. To learn more about National Medical Billing Services’ wide range of revenue cycle services and analytics, visit nationalascbilling.com.
Bill Prentice: 7:56
So, Mary, as you detailed in your presentation this week, a key feature of the planning process for ASCs is conducting at least one annual exercise where the entire staff perform several types of drills in a simulated emergency—you referenced that a little bit earlier in our podcast. Can you tell us how an ASC administrator can get the most out of one of these exercises? For instance, have you found that it’s possible to engage one or more local first responders in a planning exercise?
Mary Ryan: 8:24
These exercises really are the best way for us to prepare our teams to respond effectively and efficiently. So, tap into those experts who prepare for these events on a daily basis. Your local healthcare coalition is a really great place to start. They are formal collaborations between hospitals, public health departments, emergency management agencies and many, many other healthcare entities. They promote consistency and connectivity within that group. Ambulatory surgery centers really are just starting to become more welcomed into that group, with a little bit more regularity as of late.
Bill Prentice: 9:04
And I was going to actually ask you about that because I’m wondering whether the pandemic and obviously the stresses that put on our health system in so many markets—has that kind of opened the doors a bit do you think to better communication and better alliances going forward?
Mary Ryan: 9:20
No doubt. No question in my mind that’s what happened. As they were seeking for avenues to garner resources that they couldn’t get their hands on, they reached out to other healthcare providers. And we were probably one of the first people that they thought about, and they reached out and we thought, hey, you know, we could really utilize them and they could become a really valuable contributor to this group because of the resources that they do have that may not be able to be used or implemented with truly taking care of patients in disaster, certain disaster instances. But there’s definitely a bunch of other avenues so that we can participate, such as staffing and sending teammates over to the hospital when they are just bursting at the gills with patients and don’t have enough teammates to take care of them.
Bill Prentice: 10:09
Of course, yes. Well, Mary, I have one last question for you and it’s about communications, and you’ve talked a bit about the importance of communications in this whole process already. So, in a time of emergency, ASCs have several very distinct constituencies that they may need to communicate with, including their patients, staff, local officials, public health regulators and the media to just name a few. That’s a lot for any administrator to take on given all their other responsibilities, as you well know. Throughout the COVID-19 pandemic, ASCA created a lot of practical resources for members, and I’m sure that was very helpful. But, again, a lot of this, using those resources falls back on the administrators. What advice can you give to help them be better communicators in a time of crisis?
Mary Ryan: 10:59
So, I really believe as leaders, your team looks to you for guidance, and they really want to hear from you often, and then more often than that. My advice would be to keep your team appraised of the latest data and information related to the crisis that you’re currently in. As you update policies and procedures, be sure to educate your team. Share with them that the decisions being made are basically based on the information and requirements that you currently have available, and commit to them to informing them as soon as new information is known or available to you. I do believe it’s best to stick to the facts. I think you need to stay calm. I think you need to be positive, yet truthful about the current situation. I think being open to feedback. And one of the things that I really want to recommend for those leaders in these positions—tap into the experts, as you cannot possibly be the expert and know everything and have all the answers. Reach out to those local, state, federal agencies, those departments of public health, and help them guide you through these times of change and unknownness.
Bill Prentice: 12:13
I think that’s great advice. And also, I know that either your state ASC association or we at ASCA are always there to back you up and help and maybe provide some guidance on good communication strategies. So, don’t forget us as well. Well, listen, Mary, this has been a really fascinating podcast, and I wish I had come to your session. But I’m sure you will be talking about this in different forums and hopefully with ASCA again, and we’ll have plenty of resources on this on the ASCA website. So, thank you for sharing a few minutes with us on the ASC podcast.
Mary Ryan: 12:51
Bill Prentice: 12:52
So before concluding, I’d like to once again thank our podcast sponsor, National Medical, an ASCA affiliate and leading ASC revenue cycle company. To learn more, visit nationalascbilling.com.