Efforts to boost OR efficiency are starting to pay off
Steps under way to improve OR efficiency
Profile: Andrew Newman (scuba diver/pulmonologist)
Completion of cancer center expected in late fall 2003
Device tested at Stanford may improve breast cancer diagnosis and treatment
Rules, rules and more rules!
by: Raymond Gaeta
* * *
Every time we turn around, it seems, another set of rules, regulations and policies is being handed down by the alphabet soup of health-care regulatory agencies. My first response - and surely that of many others - is "Now what?" With the increasing complexity of medicine, the addition of new rules and policies at times seems overwhelming. After pausing and taking a collective deep breath, however, we should remember that these regulations, along with our own internal policies and bylaws, are designed to ensure the smooth operation of this institution and the safety of our patients.
Many of you are aware of the recent visits by inspectors from the Centers for Medicare and Medicaid Services (the federal agency formerly known as the Health Care Financing Administration). Stemming from those inspections, chief of staff Larry Shuer issued several memos emphasizing the importance of complying with various regulatory requirements, such as appropriate documentation prior to operative procedures. The recent push to enforce the requirements for an updated history and physical and/or completion of an integral history within seven days of surgery struck some physicians as yet another intrusion into their work of caring for patients.
Upon reflection, however, I think all of us would agree that reviewing the integral history to be sure there have been no significant changes in the patient's status is a necessary, justifiable step that helps ensure patient safety. After all, changes in the patient's underlying condition may necessitate altering the original treatment plan.
Appropriately storing and accounting for controlled substances is another regulation that makes perfect sense but might be dismissed as just another required step in the middle of a busy day caring for patients at the hospital. The reasons behind other regulations may be less obvious - or they may seem outdated relative to our current state of practice - but it's important to remember that all of them are designed to ensure patients' safety and access to medical care.
Stanford Hospital is well-equipped to respond to new regulations and stepped-up enforcement of existing regulations. After the initial audit by officials of the Centers for Medicare and Medicaid Services, for example, the hospital formed special committees to resolve issues raised by the auditors. I was impressed by the prompt way in which solutions were put forward, and by the way the committee sought out and incorporated physicians' and nurses' input. Members of our hospital staff will be working with the regulatory agencies to clarify some regulations and possibly bring about changes to make them more relevant to our current state of practice.
Aside from the regulations promulgated by various agencies, we have many internal rules - beginning with our bylaws - that are periodically reviewed and revised. The bylaws committee, headed by medical staff vice president Bruce Adornato, will be meeting soon to suggest changes that will better clarify what is expected of our physicians. These changes will help us provide the best possible care for our patients. The bylaws that will be reviewed for possible changes include the rules laying out how and when physician privileges will be suspended for failing to complete a patient's medical records or failing to properly sign off on verbal orders. These changes must balance external regulations with the current state of our medical records infrastructure.
Again, keep in mind that these rules are intended to improve patient safety. Completing the medical record ensures that we have the best and most up-to-date information available on our patients. Additionally, the requirement for signing off on verbal orders is designed to ensure that the medications and treatments ordered for our patients actually reach the intended patients in a timely manner.
Our ability to comply with various rules and regulations ultimately depends on the infrastructure and personnel that support all the processes involved. Individuals such as Rebecca Partridge, director of accreditation and regulatory affairs, make sure we're up-to-date on all the applicable regulations, and that the most critical or time-sensitive ones get immediate attention. Without the help of such people, the myriad regulations would clearly overwhelm any individual physician who attempted to understand them.
Physician participation and feedback are essential to make sure the rules that govern us are sensible. If we lay out our case in a clear and reasonable way, perhaps we can prompt some of the regulatory agencies to clarify or revise their more ambiguous, arbitrary rules.
* * *
Your suggestions for clarifying rules and policies are welcome. Please contact me at 725-5352 or at gaeta@stanford.edu
