Standardizing Ambulatory Care Procedures in a Public Hospital System to Improve Patient Safety

Excerpt

The Medical Center of Louisiana at New Orleans (MCLNO) provides care to primarily indigent and medically underserved patients in Louisiana. The hospital and ambulatory clinics serve as a clinical laboratory for students from schools of medicine, pharmacy, and nursing, and allied health programs. In response to a potential threat to patient safety, an initial review of the dental procedures performed at MCLNO was done, and then a review of all procedures approved for the medical staff credentialing process was performed. The initial findings revealed a lack of standardization of patient flow and process for ambulatory procedures, disparities in perioperative evaluations, inadequate nursing care in the immediate postoperative period, and problems in the environments for performing procedures. A multidisciplinary team was assembled to review all procedures and develop standardized processes to improve patient safety for ambulatory procedures. To determine the appropriate level of care for patients, perioperative evaluations, monitoring and followup, nursing practice standards, clinical practice guidelines, and Medicare ambulatory procedure codes were reviewed. Following review, recommendations were adopted by the Medical Staff's Credentials Committee to update the standard credentials for each department and to grant additional privileges for credentialed members of the medical staff based on training, competencies, and experience.