Nicholas B. Frisch, MD, MBA, shared his thoughts on the importance of comprehensive screening and how physicians can implement it with Becker's ASC Review.
Dr. Frisch is an orthopedic surgeon specialized in hip and knee replacement. He performs inpatient cases at Ascension Crittenton Hospital in Rochester, Mich., and outpatient cases at Michigan Institute for Advanced Surgery in Lake Orion, Mich.
Note: Responses have been edited for length and clarity.
Question: How can physicians incorporate comprehensive screening into their practices?
Nicholas Frisch: First, you have to identify what your comfort level is with performing outpatient procedures. Next, you have to establish the criteria you are going to use, develop the process in your clinical pathways to incorporate that process and finally create a mechanism for ensuring standardization and follow-up.
Q: What else should physicians know about comprehensive screening and best practices?
NF: Take the time to see other practices performing outpatient joint replacement before just jumping in. There is a lot involved on the front end, in the office and [in the] clinic that needs to be appropriately addressed prior to going to the outpatient environment. By incorporating certain practices initially, you can help ensure patient safety and ultimately improve outcomes and satisfaction on the back end.
Q: What kinds of negative outcomes can result from not performing comprehensive screening?
NF: If you take someone who is unfit for outpatient surgery to a freestanding ASC, you risk the possibility of running into a complication that simply cannot be addressed in an ambulatory environment. Each center has a different process for managing these complications, but most will have an ambulance available to take patients to a nearby hospital for enhanced level of care. That can be a devastating outcome.
With appropriate selection criteria, several studies have shown no increase in hospital readmission, mortality, [emergency department] visits, blood clots and pain compared to inpatient procedures. If you don't screen patients properly, that may not hold true and the results could be significantly worse outcomes and increased complications.
