What does it take to manage an ASC?

Key Points

"Managing Your ASC" is a new, ongoing forum for addressing your questions related to managing your present or future ASC. Our question and answer format will provide you with real-world solutions to concerns such as:

Because I get a lot of questions regarding staffing issues, let's start off with a few facts related to staffing your ASC.

Scheduling RNs

It's important to know that CMS clearly defines how the staff of an ASC should be organized. According to CMS standard number 416.46(a), "Patient care responsibilities must be delineated for all nursing service personnel. Nursing services must be provided in accordance with recognized standards of practice. There must be a registered nurse available for emergency treatment whenever there is a patient in the ASC."

CMS also has Interpretive Guidelines, which define how the agency interprets this standard. According to those standards, "available" means on the premises and sufficiently free from other duties to enable the individual to respond rapidly to emergency situations. Functions, qualifications, and patient care responsibilities should be delineated for all nursing personnel.

In the interpretive guidelines, CMS describes how it will survey this standard. CMS will select a random sample of surgical cases, and they will look at your staffing schedule to ensure you had adequate nursing and ancillary staff to meet the needs of the patients that day. ASC policy must explain current acceptable standards of practice. Recognized standards of practice are standards promoted by national, state, and local nursing associations relating to safe and effective nursing services. While this is the CMS standard of care for staffing standards, most state standards are aligned with these CMS standards.

Now that we know what the standard says, what does it mean? Let's go through the steps and define what each one means.

"Patient care responsibilities must be delineated for all nursing service personnel." Every position title in your facility must have a job description. A signed job description should be in each employee's file. If an employee has more than one job description, such as a nurse who works in the operating room (OR) and the post anesthesia care unit (PACU), then the employee should have two signed job descriptions in his or her file-one for the OR and one for the PACU. In addition to job descriptions, the center must prove competency on all staff at your facility. An example would be having documentation in an employee's file that he or she is competent to start an IV.