Chapter 17: Risk Management in Office Based Surgery Office Base Surgery (OBS) Invasive procedures requiring general anesthesia and deep or moderate sedation which are performed in a doctor’s office separate from a hospital or ambulatory surgery center (ASC). Technological advances and economic incentives led to a shift from hospital to ASC and now to office based surgeries. Decrease in invasiveness of surgical procedures Decrease in invasiveness of anesthesia Concerns with OBS Safety and ease of a procedure may entice physician to perform procedures they are not familiar with Regulation of OBS is voluntary though is mandated in some states As CMS did not allow facilities fees for procedures performed in OBS, they did not participate in regulating OBS practice as was done with other emerging healthcare entities Sources of Risk in OBS Informed Consent and Breach of Contract Bleeding, Thromboembolism and Infections Perforation of Viscus and Drug Toxicity Interference with Pacemakers Anesthetic Complications Infection Control Preexisting Condition Complications Incorrect surgical procedure Unplanned hospital admission from complications Death Legal Requirements for OBS Practices Naming Designation Corporate Designation Referrals Contracts between physicians and hospitals Other Requirements Some states require OBS to follow ASC regulations while others have established OBS specific regulations. In general OBS should: Seek accreditation Follow personnel requirements for education, training, licensing, board certification, hospital privileges and scope of practice Select appropriate procedures to perform Track and report adverse events Accreditation and Clinical Guidelines Currently there are 3 accrediting organizations for OBS facilities with very similar standards: AAAHC AAAASF TJC Clinical Practice Guidelines developed by professional associations should be adopted by the OBS as applicable Management Practices OBS facilities should have effective and efficient management practices in the following areas: Personnel Management Facility Management Medical Records Management Quality Management Communications with patients Clinical Practice Safety OBS facilities should have effective and efficient clinical practice safety in the following areas: Preoperative Practices Intraoperative Practices Postoperative Practices Summary The number OBS facilities continue to grow due to satisfaction of patients and practitioners Risk management is an important consideration for the OBS facility as ease and safety of procedures may lead towards inappropriate selection of services Chapter 16: Risk Management in Long-Term Care Institutions Department Of Health & Human Services. (2011, February 10). A profile of older americans: 2011. Retrieved from Administration on Aging website: http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2011/4.aspx Increasing Liability in Long Term Care Settings General and professional liability ins ...

1. Chapter 17: Risk Management in Office Based Surgery
Office Base Surgery (OBS)
Invasive procedures requiring general anesthesia and deep or
moderate sedation which are performed in a doctor’s office
separate from a hospital or ambulatory surgery center (ASC).
Technological advances and economic incentives led to a shift
from hospital to ASC and now to office based surgeries.
Decrease in invasiveness of surgical procedures
Decrease in invasiveness of anesthesia
Concerns with OBS
Safety and ease of a procedure may entice physician to perform
procedures they are not familiar with
Regulation of OBS is voluntary though is mandated in some
states
As CMS did not allow facilities fees for procedures performed
in OBS, they did not participate in regulating OBS practice as
was done with other emerging healthcare entities
Sources of Risk in OBS
Informed Consent and Breach of Contract
Bleeding, Thromboembolism and Infections
Perforation of Viscus and Drug Toxicity
Interference with Pacemakers
Anesthetic Complications
Infection Control
Preexisting Condition Complications
Incorrect surgical procedure

2. Unplanned hospital admission from complications
Death
Legal Requirements for OBS Practices
Naming Designation
Corporate Designation
Referrals
Contracts between physicians and hospitals
Other Requirements
Some states require OBS to follow ASC regulations while
others have established OBS specific regulations. In general
OBS should:
Seek accreditation
Follow personnel requirements for education, training,
licensing, board certification, hospital privileges and scope of
practice
Select appropriate procedures to perform
Track and report adverse events
Accreditation and Clinical Guidelines
Currently there are 3 accrediting organizations for OBS
facilities with very similar standards:
AAAHC
AAAASF
TJC
Clinical Practice Guidelines developed by professional
associations should be adopted by the OBS as applicable

3. Management Practices
OBS facilities should have effective and efficient management
practices in the following areas:
Personnel Management
Facility Management
Medical Records Management
Quality Management
Communications with patients
Clinical Practice Safety
OBS facilities should have effective and efficient clinical
practice safety in the following areas:
Preoperative Practices
Intraoperative Practices
Postoperative Practices
Summary
The number OBS facilities continue to grow due to satisfaction
of patients and practitioners
Risk management is an important consideration for the OBS
facility as ease and safety of procedures may lead towards
inappropriate selection of services
Chapter 16: Risk Management in Long-Term Care Institutions
Department Of Health & Human Services. (2011, February 10).
A profile of older americans: 2011. Retrieved from
Administration on Aging website:

4. http://www.aoa.gov/AoARoot/Aging_Statistics/Profile/2011/4.a
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Increasing Liability in
Long Term Care Settings
General and professional liability insurance costs have been
increasing with the number of lawsuits and awards.
Though frequency of claims may have actually decreased in the
last several years, the severity of claims have increased
resulting in a higher than average loss per paid claim.
Tort reform has also impacted long-term care liability lawsuits
and paid claims.
What is Long Term Care?
Medical and non-medical care to people who have a chronic
illness or disability.
Long-term care can be provided at home, in the community, in
assisted living or in nursing homes
Most long-term care assists people with support services such as
activities of daily living (ADLs).
Aspects of Long Term Care
Aging population coupled with longer life and multiple medical
conditions
Long term care regulations
Various types of long term care providers
Institutional/Residential Care
Subacute Care
Community-Based Care
Home Care

5. Nursing Facilities
These facilities provide care to people who can't be cared for at
home or in the community and provide a wide range of personal
care and health services.
This care generally is to assist with support services for people
who can’t take care of themselves due to physical, emotional, or
mental problems.
Regulatory Enforcement of
Nursing Facilities
Oversight is split between federal and state authorities
OBRA 87 established a Residents’ Bill of Rights
Quality of Care Initiatives
State Inspections
Statement of deficiencies and Plan of Correction is a detailed
report of the facility’s perceived failures to meet CMS standards
Sanctions for unmet requirements
False or Deceptive Marketing
Marketing materials can be utilized in lawsuits as evidence of
the high-quality care that the facility failed to provide.
There are substantial fines for falsely advertising services or the
results of services as they may be settled as a deceptive trade
practice.
Malpractice insurance does not cover this.
Physiology of Aging
Decreases or declines in:
brain weight - cognitive ability
immune response - thermal response

6. renal/pulmonary function - glucose tolerance
Changes in absorption, metabolism and clearance of drugs
Lower ability to detoxify alcohol
Changes in sight, hearing, taste, touch and smell
Nocturnal waking
Sundowning
Risks for the Elderly
Accidents: Fall and Nonfalls
Medication Errors
Infection Control
Pressure Ulcers
Dementia
Elopement/Wandering
Restraints
Therapy and Dietary Services
Disaster Planning and Fire Safety
Elder Abuse and Violence
Elder Justice Act of 2009
Elder Abuse consists of:
Physical abuse
Sexual abuse
Psychological abuse
Financial exploitation
Neglect
Employee Risks
Risks posed by employees may be avoided with appropriate and
thorough hiring practices
Proper screening of applicants

7. Background checks
Credential verification
Risks posed to employees may include
Abuse or violence from residents
Ergonomics
Occupational Hazards
Subacute Care
Subacute care is considered a transitional phase designed to
return patients to independent living quickly and at a lower
cost.
It focuses on patient who need assistance after a serious illness
or injury, but who do not require the full services of a hospital
setting.
Subacute units/facilities may be subject to different licensing
requirements than nursing facilities.
Home Health Care
Assistance at home from family, friends, volunteers or paid
healthcare workers.
Some home care can only be given by licensed health workers
Home healthcare services must be ordered by a physician and
are subject to regulation
Agencies receiving payment from Medicare or Medicaid must
meet CMS requirements
Home Health Care Risks
Risks from the home environment
Informed consent
Termination of care
Incident Reporting
Falls
Use of Technology in the home

8. Home Health Employees
Negligence
Safety of Employees
Hospice Care
Palliative Care for patients who are within six months of death
as determined by the physician
Performed in the home, hospital, nursing facility or other long
term care facility
Risk mirrors those found in home health and long-term care
facilities.
Summary
Population is getting older with increasing poor health
Family/friends care availability is very limited – therefore,
methods of providing long term care other than family/friends is
needed
Most long term care facilities/organizations are highly regulated
though some of the newer agencies/services are not yet under as
strict regulation
Final Project: Risk Management Plan
Objective:
For this assignment, you will create a Risk Management Plan
for a Community Health Center of your choosing, The Risk
Management Plan is designed to support the mission and vision
of the Facility you choose as it pertains to clinical risk and
patient safety as well as visitor, third party, volunteer, and
employee safety. You are encouraged to choose any Health Care
Facility: Hospital, Doctor Office, Emergency Care Center, etc.
The project will be 8-10 pages long including title page and

9. reference page.
ASSIGNMENT GUIDELINES ( 20 points/ 10%):
Students will generate Risk Management Plan for a Community
Health Center to support the mission and vision of the Health
Care facility as it relates to clinical risk and patient safety as
well as visitor, third party, volunteer, and employee safety. The
paper will be 8-10 pages long (including title page and
reference page). You need to apply all the concepts studied in
this plan. Each paper must be typewritten with 12-point font and
double-spaced with standard margins. Follow APA format when
referring to the selected articles and include a reference page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Introduction (50 points / 25%) Provide a brief synopsis of
Importance of the Risk management as an integral component of
a healthcare (not a description), in your own words.
2. Your Risk Management Plan (10 points / 50%)
a. Presentation Page:
ORGANIZATION NAME
BUSINESS ADDRESS
CITY, ST, ZIP
TELEPHONE NUMBER
FACSIMILE NUMBER
WEBSITE ADDRESS
EMAIL ADDRESS
b. MISSION STATEMENT: Mention the organization’s mission.
New Page.
c. Purpose of your Risk Management Plan: The purpose of your
risk management program is to protect patients, staff members
and visitors from inadvertent injury. New Page
d. Authority and Role of the Risk Manager: Mention and state
the major functions and responsibilities of the Risk Manager in
your organization. Job’s description.
e. Scope of your Risk Management plan: Under the direction of

10. the risk manager, the risk management program provides for
collaboration among all departments, services, and patient care
professionals within the organization. Mention the departments
will be influence by this Risk management plan.
f. Objectives of the Risk Management Program
g. Specific Components of the Risk Management plan
The risk management program will include the following
components:
g.1 Event/Incident/Occurrence reporting
g.2 Educational activities
g.3Management of patient and family complaints/grievances
g.4 Patient satisfaction
h. CLAIMS MANAGEMENT: In some organizations, claims
management is a function outside the risk management program
and may have a separate staff with unique policies, procedures
and protocols. If the claims management function is included in
the risk management plan, you should constitute of their
elements.
i. REPORTS TO THE GOVERNING BODY
j. ANNUAL EVALUATION OF THE RISK MANAGEMENT
PROGRAM.
3. Conclusion ( 20 point/ 15%)
Briefly recapitulate your thoughts & conclusion to you Risk
Management plan. How did this Management plan impact your
thoughts on Health Care Administrator?
Evaluation will be based on how clearly you respond to the
above, in particular:
a) The clarity with which you consolidate, stablish and apply
your knowledge to generate the Risk Management Plan;
b) The depth, scope, and organization of your paper; and,
c) Your conclusions, including a description of the impact of
the Risk Management plan on any Health Care Setting.