AAAHC Quality Roadmap 215 Accreditatio Survey Results
FROM THE PRESIDENT AND CEO This report is a chace to pause, take stock, ad tell the story of AAAHC-accredited orgaizatios at a poit i time. We do this aually, ad the process serves to iform refreshed educatioal offerigs ad revised Stadards for the comig year. Three years ago, AAAHC made the decisio to share this aalysis publicly. This year s report cosists of a thorough review of compiled data from 13 moths (Jue 214-Jue 215) of completed surveys, ad a aalysis of fidigs with regard to compliace with 214 Stadards. I additio to a thematic overview, we ve grouped datasets based o broad practice types: ASCs, office-based facilities, ad primary care settigs. This allows readers a iformal opportuity to bechmark the compliace of their orgaizatio agaist that of their peers. We do t wat you to reivet the wheel; if you re challeged by a particular Stadard or topic represeted by a group of Stadards, it s likely that other, like-orgaizatios are, too. So i additio to idetifyig those Stadards with a high-icidece of partial- (PC) or o-compliat (NC) ratigs by surveyors, we re offerig additioal support to help you improve i those areas. Cosider this a quality roadmap to guide your orgaizatio s performace. Sice the first release of these data (previously preseted as the AENEID Report), some topics have appeared aually across orgaizatios of all types ad sizes. Various Stadards related to documetatio ad others focused o quality improvemet cosistetly make the list of those with the highest frequecy of deficiecies. We have placed a additioal emphasis o these topics i our webiars, at Achievig Accreditatio, i toolkits developed by the AAAHC Istitute for Quality Improvemet, ad i our ewsletters. We ll cotiue to develop tools to allow you to build a robust library of resources addressig these topics. I ivite you to take advatage of them. This year, for the first time, issues of compliace with safe ijectio practices appeared as a recurrig theme across all orgaizatios. As a patiet safety issue, we caot stress eough how importat it is for every healthcare orgaizatio to follow the guidelies of the Ceters for Disease Cotrol ad Prevetio s Oe ad Oly Campaig, a effort i which AAAHC is a foudig parter. This documet will be most helpful whe read i cojuctio with the 214 or 215 editio of the Accreditatio Hadbook for Ambulatory Health Care ad your most recet survey report. Sicerely, Stephe A. Marti, Jr., PhD, MPH Presidet ad CEO The Accreditatio Associatio 2
I. DESCRIPTION OF THE DATA The iformatio i this report comes from AAAHC surveyors ratigs of compliace with our 214 Stadards ad their commets detailig the ature of ay deficiecies foud. The data were collected durig osite surveys of orgaizatios seekig iitial or re-accreditatio, icludig ambulatory surgery ceters i the Medicare Deemed Status program. This report icludes data collected over 13 moths (Jue 214 - Jue 215). It does ot iclude focused surveys those that did ot iclude all core Stadards (Chapters 1-8 of the Accreditatio Hadbook) or those that were the result of a radom selectio to cofirm cotiued compliace or some required iter-cycle activity. Results of surveys for orgaizatios i our health pla program are ot icluded. The data poits represet 1399 complete surveys. The illustratio to the right shows the distributio of surveys for this period by the most commoly described orgaizatioal types: ambulatory surgery ceter (ASC), Medicare deemed status ASC, office-based surgery facility (OBS), ad primary care settig (PC). PC icludes military (U.S. Air Force ad U.S. Coast Guard), commuity health, Idia health, occupatioal health, studet health, ad other primary care settigs. I III. ANALYSIS OF FINDINGS BY SETTING, you will fid additioal data o a subset of ASCs, specifically those participatig i the AAAHC/Medicare Deemed Status program, ad o studet health orgaizatios ad Patiet Cetered Medical Homes (PCMH), each a subset of PC. II. OVERALL FINDINGS High compliace Surveyors rate AAAHC Stadards as substatially compliat (SC), partially compliat (PC), or o-compliat (NC). The highest compliace fidigs (1% rated SC across all orgaizatio types) idicate that AAAHC-accredited orgaizatios treat patiets with respect, cosideratio ad digity, ad provide them with the opportuity to participate i decisios ivolvig their health care. These orgaizatios have o icosistecy i their use of idetifiers withi idividual cliical records ad, whe aother party is resposible for makig healthcare decisios o behalf of a patiet, this perso is likewise, appropriately idetified. 25 HIGHEST OVERALL DEFICIENCIES We also fid that AAAHC-accredited orgaizatios cosistetly address the coordiatio ad/or trasfer of care whe a patiet requires cosultatio with a specialist. Most commo deficiecies across all orgaizatios While this report looks i depth at those Stadards with the highest icidece of PC ad NC ratigs by surveyors, most orgaizatios that seek AAAHC accreditatio successfully achieve a three-year term. This year we are focusig o the four topics that offer the greatest opportuity for improvemet. PERCENT 3 OBS 1% MDS ASC 22% 2 15 1 5 PC 1% ASC 58% 2.II.D 2.III.H 5.I.C 6.F 7.I.C.2 Credetialig, Privilegig, Quality Docume- Safe Ijectio Peer Review Improvemet tatio Practices 214 STANDARD IDENTIFIERS 1. Safe ijectio practices Stadard 7.I.C.2 requires that the orgaizatio select atioally-recogized guidelies for safe ijectio practices, use these guidelies to educate providers ad as a bechmark for surveillace activities. This is the first year that deficiecies related to safe ijectio practices have appeared i this report. Oe possible reaso is the lauch i mid- 214 of reportig madated by the Ceters for Medicare ad Medicaid Services (CMS) of ifectio cotrol breaches. The reportig requiremets specifically relate to istaces of potetial cross-cotamiatio through re-use of eedles or syriges, or iappropriate use of multi-dose vials. Heighteed awareess of this issue o the part of surveyors, may have led to a icrease i the frequecy with which
deficiecies were cited across all orgaizatio types. The ed result is this: a importat aspect of patiet safety has bee brought to the forefrot of a accreditatio survey. AAAHC parters with the Ceters for Disease Cotrol ad Prevetio (CDC) i the Oe ad Oly Campaig to promote safe ijectio practices. Guidace from the Oe ad Oly Campaig SINGLE USE VIALS Vials that are labeled as sigle-dose or sigle-use should be used for a sigle patiet ad sigle case/procedure/ijectio. There have bee multiple outbreaks resultig from healthcare persoel usig sigle-dose or sigle-use vials for multiple patiets. Eve if a sigle-dose or sigle-use vial appears to cotai multiple doses or cotais more medicatio tha is eeded for a sigle patiet, that vial should ot be used for more tha oe patiet, or should it be stored for future use o the same patiet. To prevet uecessary waste or the temptatio to use cotets from sigle-dose or sigle-use vials for more tha oe patiet, cliicias ad purchasig persoel should select the smallest vial ecessary for their eeds whe makig treatmet ad purchasig decisios. MULTI-DOSE VIALS Multi-dose vials should be dedicated to a sigle patiet wheever possible. If multi-dose vials must be used for more tha oe patiet, they should ot be kept or accessed i the immediate patiet treatmet area. This is to prevet iadvertet cotamiatio of the vial through direct or idirect cotact with potetially cotamiated surfaces or equipmet that could the lead to ifectios i subsequet patiets. If a multi-dose vial eters the immediate patiet treatmet area, it should be dedicated to that patiet oly ad discarded after use. 2. Credetialig, Privilegig, ad Peer Review Stadard 2.II.D is iteded to esure that all services offered by the orgaizatio are provided by health care professioals idetified by the goverig body as qualified to deliver them. It appears as a high-deficiecy Stadard for the third cosecutive year. Issues cosistetly idetified by surveyors i citig compliace problems with this Stadard iclude: Failure to provide a comprehesive list of privileges for the activities of a provider, i.e., use of specific techologies or equipmet, performace of procedures, or tasks (especially supervisio of others). This may be a result of a orgaizatio addig services or equipmet ad failig to review ad edit privilegig forms ad/or failig to obtai ad documet approval of these chages by the goverig body. Failure to assig a time limit to iitial privilegig, or to meet the requiremet of the Stadard (or the orgaizatio s ow policy if it is more striget) for reewal of privileges. Less frequet, but a critical breach i compliace, is iappropriate credetialig ad privilegig. This occurs whe a orgaizatio fails to idepedetly verify credetials, whe a provider sigs off o his/her ow privileges, or whe privileges are grated based o those approved by aother health care facility. Each orgaizatio is expected to perform its ow credetialig (either by primary source verificatio, secodary source verificatio, or by usig a CVO) ad privilegig. Related Stadard 2.III.H appears for the secod year i a row. This Stadard requires that the results of peer review are used as a part of the process for gratig cotiuatio of privileges. Surveyor commets reflect missig evidece that peer review was cosidered at the time of re-appoitmet. May orgaizatios use provider dashboards to documet peer review. These ca be icorporated ito the re-appoitmet applicatio process. This is a easy meas of iteral bechmarkig; Dashboards ca visually idetify high ad low performers compared to a orgaizatio s goals, ad thereby provide a meas of itegratig peer review with quality improvemet. See V. ROADMAP FOR IMPROVEMENT 216 for additioal resources. Credetialig, privilegig ad peer review are three separate but related processes. Credetialig meas validatig a provider s qualificatios to offer healthcare services. Privilegig is the process of goverig body approval for a provider to deliver specific treatmets, procedures, or to use specific equipmet. Peer review is the process of cofirmig a provider s competece by elistig others of similar licese to review cliical records, ad other aspects of care, e.g., ifectio rates, compliace with medical staff rules ad regulatios, patiet satisfactio surveys. 4
3. Quality Improvemet Stadard 5.I.C addresses quality improvemet studies ad makes its third cosecutive appearace o the list of high-frequecy deficiecies across all orgaizatio types. Quality Maagemet ad Improvemet Stadards (Chapter 5) are iteded to cotiuously improve patiet care ad to promote effective, efficiet use of resources. AAAHC expects that this is accomplished through a active, itegrated, orgaized, data-drive program that liks peer review, QI activities, ad risk maagemet. The Stadards drive this itet by focusig o: 1. The overall QI program (Stadard 5.I.A) 2. O-goig data collectio processes (Stadard 5.I.B) 3. Bechmarkig (Stadard 5.I.D) 4. Documetatio of improvemet (Stadard 5.I.C) Surveyor commets provided whe Stadard 5.I.C is rated PC or NC usually cite: No clearly stated, quatitative goal No statemet of compariso betwee curret performace ad goal Icomplete study No reportig to goverig body Hits for meetig QI Stadards The essece of QI is quatifiable improvemet. Without idetifyig the curret state, the goal, the trasitioal activity, ad the ew state, it is difficult to demostrate improvemet. IMPROVING GOAL SETTING 1. Use a idetified bechmark agaist which to measure your curret performace. 2. Use the SMART acroym to write your goal. IMPROVING DOCUMENTATION Close the loop. Whe a successful QI effort is completed, write it up as a study ad share it throughout your orgaizatio. 4. Documetatio AAAHC surveyors have three meas of assessig compliace: persoal observatio while o-site, resposes to iterviews they coduct with orgaizatio staff, ad documeted evidece. For may Stadards that are applicable to all orgaizatios, writte documetatio is the primary way to cofirm that the requiremet is beig met. Requiremets for documetatio appear throughout the Stadards. Surveyor fidigs Commets provided whe these Stadards are rated PC or NC cover the full rage of required documetatio. For example: S Specific The goal is clear ad easy to uderstad. It traslates ito actio by usig words like icrease or decrease. M Measureable The goal is objective ad ca be assessed by gatherig quatitative data, e.g., 25%, 2 miutes, all, oe. A Achievable Those resposible for the goal have the kowledge, skills ad resources to deliver the result. R Relevat The goal matches the purpose, e.g., improves compliace, icreases patiet satisfactio, saves moey. T Time-boud The goal has a completio date, e.g., by 12/31, third quarter. No privilege lists; lists did ot iclude all procedures performed; o documeted privileges for supervisio; o documeted approval of privileges Allergies/reactios ot cosistetly documeted No-drug allergies, e.g., OTC, herbals, materials/utoward reactio ot assessed H&Ps icomplete 5
No evaluatio of emergecy drills No evidece that peer review is cosidered at re-appoitmet Stadard 6.F is a very specific example of a documetatio issue that is frequetly cited i survey reports. The Stadard requires that allergies ad utoward reactios are recorded clearly ad cosistetly i patiet cliical records. While EMRs have largely solved the problem of a cosistet locatio for this iformatio, verificatio at each ecouter is frequetly missed. To address this Stadard more fully, record whatever iformatio the patiet is able to provide, eterig ukow as a respose if he/she is uable to describe the reactio. Avoid NKDA (o kow drug allergies) i favor of NKA (o kow allergies) whe a patiet does ot idicate ay sesitivities. The value of documetatio Requiremets for writte documetatio ca be perceived as burdesome. Cosider that: 1. Documetatio promotes cosistecy. Everyoe egaged i a documeted process will follow the same steps. 2. With a documeted policy or process, a variatio i result ca be idetified quickly to pipoit a problem or embrace a improvemet opportuity. 3. Your orgaizatio becomes accreditable because you memorialize your approach to quality. This ca pay divideds whe egotiatig with payors or liability isurers, ad it is essetial should you become the target of litigatio. III. ANALYSIS OF FINDINGS BY SETTING Most commo deficiecies, Ambulatory Surgery Ceters (ASCs) 2 ASC NON-MEDICARE DEEMED HIGHEST DEFICIENCIES 15 PERCENT 1 5 2.II.B.5 2.II.D 2.III.H 5.I.C 5.I.C.2 6.F 7.I.C.2 Credetialig, Privilegig ad Quality Improvemet Documetatio Safe Ijectio Peer Review Practices 214 STANDARD IDENTIFIERS Three Stadards related to credetialig, privilegig, ad peer review are amog the highest-frequecy deficiecies for ASCs. Stadards 2.II.B.5, 2.II.D, ad 2.III.H are most ofte rated PC or NC because the orgaizatio has failed to meet requiremets for re-credetialig/re-privilegig per its ow policies or at least every three years. Verificatio of all items is required at the time of iitial credetialig ad aythig with the potetial to expire (licese, DEA registratio) or chage (liability claims history, Medicare/Medicaid sactios, privilegig limitatios, for example) must be verified agai at each re-credetialig/re-privilegig iterval. Ofte a accurate delieatio of privileges (DOP) is missig. Some orgaizatios failed to iclude privileges for supervisio of others especially for the admiistratio of aesthesia or to update privilege lists to iclude all procedures performed. Most of these issues are correctable by reviewig ad updatig the process of credetialig ad privilegig to make it more robust. The patiet safety toolkit o Credetialig ad Privilegig released i 215 6
icludes a caledar template that may be useful. Similarly, peer review deficiecies reflected a process error. Surveyor commets iclude: Peer review was ot cosidered at the time of reappoitmet. Peer review was ot liked to quality improvemet. Peer review was ot performed by a similarly licesed peer. Stadards cited from Chapter 5 relate to QI studies. The specific elemet (5.I.C.6) that is a high-frequecy deficiecy for ASCs is the compariso of curret performace to the idetified performace goal. Partial- or o-compliace arises whe oe or both of these compoets is ot writte as a quatitative statemet (see SMART goals, page 5 ). Medicare Deemed Status ASCs 8 ASC MEDICARE DEEMED STATUS HIGHEST DEFICIENCIES 7 PERCENT PERCENT 6 5 4 3 2 1 2.II.D 5.I.C 6.F 7.I.C.2 416.48(a) 11.I 8 8.E 8. 416.44(b)(1) Credetialig, Quality Documetatio Safe Ijectio Eviromet Privilegig Improvemet Practices ad Peer Review The Chapter 8 (Facilities ad Eviromet) Stadards most ofte cited reflect issues with fire drills (ot coducted frequetly eough or isufficietly documeted) ad with required ispectio ad testig of fire suppressio systems. Also sigificat for Medicare deemed ASCs are lapses i documetatio. Does your orgaizatio complete all the steps outlied i your policies? Do you have a system to esure that cliical records are complete? Most commo deficiecies, Primary Care Orgaizatios 2 15 1 214 STANDARD IDENTIFIERS 25 PRIMARY CARE HIGHEST DEFICIENCIES 5 2.II.B.5 2.II.D 2.III.H 5.I.A.8 5.I.C 5.I.C.2 5.I.C.6 5.I.C.8 6.F 6.O.1 7.I.C.2 8.O Credetialig, Privilegig Quality Documetatio Safe Ijectio Eviromet ad Peer Review Improvemet Practices 214 STANDARD IDENTIFIERS 7
For primary care orgaizatios, the highest frequecy PC or NC ratig is for Stadard is 6.F: the promiet, cosistet documetatio i idividual cliical records of allergies or utoward reactios to drugs or materials. Other deficiecies are cosistet with OVERALL FINDINGS (pages 3-6). The oly outlier is 8.O which tells us that primary care orgaizatios are ot performig ad/or documetig tests of their fire suppressio systems. This is the equivalet of a missed Life Safety Code requiremet for a Medicare-deemed ASC. Studet Health The issues uique to studet health settigs are see i the chart below. Most PC or NC ratigs for a specific Stadard occur i fewer tha 1% of surveys. The most frequetly oted deficiecy is 8.L, the requiremet that space allocated for a particular fuctio or service is adequate. While this may ot be easily correctable, these orgaizatios should be aware of the potetial domio effect for privacy, either durig patiet ecouters or with regard to security of cliical records. Also edgig over 1% is 7.I.C.2, the selectio of a atioal protocol for safe ijectio practices. 15 STUDENT HEALTH HIGH LEVEL DEFICIENCIES (DIFFERENT THAN PRIMARY CARE OVERALL) 12 PERCENT PERCENT 9 6 3 Medical Home (PCMH) 3.B.4.a 4.E.8 5.I.A.9 5.II.G.5 7.I.C 7.I.C.2 7.I.E 8.L 8.N 214 STANDARD IDENTIFIERS For orgaizatios seekig accreditatio icludig review of medical home (PCMH) Stadards, the chart below illustrates patters of compliace issues with the Stadards i Chapter 25. 6 5 4 3 2 1 PCMH HIGH LEVEL DEFICIENCIES A A.1 A.3 A.13 A.14 A.16 B.2 C.2 C.2.b C.2.f E.6 E.6.a E.6.b E.6.c E.6.d Relatioship Access Comprehesive Care Quality Improvemet 214 STANDARD IDENTIFIERS Stadard 25.A relates to the patiet/provider relatioship. Surveyor fidigs idicate that the most frequetly deficiet elemet i this group was, iroically, the explaatio of the Medical Home approach to care. Stadard 25.B.2 addresses access to the Medical Home. Stadard 25.C covers comprehesiveess of care ad the high deficiecy elemet is a scope of services that icludes ed-of-life care. Stadard 25.E is Medical Home quality improvemet ad the elemets that are frequetly missig are studies that address the issues of relatioship, accessibility, comprehesiveess, ad/or cotiuity of care. Accredited Medical Home orgaizatios appear to be more comfortable executig QI studies o cliical topics. 8
Most commo deficiecies, Office-Based Surgery 3 OBS HIGHEST DEFICIENCIES 25 2 PERCENT 15 1 5 2.II.B.3.f 2.II.B.5 2.II.D 5.I.C 5.I.D.1 5.I.D.2 5.I.D.3 4.E.4 6.E 6.F 7.I.C.2 8.E Credetialig Quality Improvemet & Documetatio Safe Ijectio Emergecy & Privilegig Exteral Bechmarkig Practices Drills 214 STANDARD IDENTIFIERS OBS is a orgaizatio type desigated by AAAHC to idicate a smaller surgical settig, specifically oe with four or fewer physicias ad two or fewer procedure rooms. We typically see a greater umber of Stadards rated PC or NC i these orgaizatios. Accreditatio is a ope book test ad smaller orgaizatios should seek out additioal resources to assist them i meetig Stadards about which they are ucertai. (See V. ROADMAP FOR IMPROVEMENT 216.) The Stadards cited above from Chapter 2 relate to credetialig ad privilegig at a basic level. Eve a sigle provider orgaizatio is required to demostrate a process that icludes review of credetials ad privileges o at least a trieial basis; a outside physicia or detist must provide this service to a solo provider. Elemets of Stadard 5.I.C refer to documeted quality improvemet studies ad have bee discussed i a earlier sectio of this report. Stadard 5.I.D focuses o exteral bechmarkig. It is importat for orgaizatios, regardless of size, to idetify best practices resultig i key performace measures. Medical specialty associatios may be a resource for this kid of iformatio. Participatio i AAAHC Istitute bechmarkig studies is aother optio to help achieve compliace with the elemets of this Stadard. The documetatio theme is represeted by Stadards 4.E.4 (medicatio recociliatio), 6.E (the requiremet that a patiet s cliical record icludes a summary of past ad curret diagoses ad procedures i order to facilitate cotiuity of care), ad 6.F (covered i II. OVERALL FINDINGS). Stadard 7.I.C.2 is discussed i detail i the overall fidigs o safe ijectio practices (page 4). Stadard 8.E covers quarterly emergecy drills. Problems with this Stadard rage from failure to perform drills to failure to evaluate, idetify, ad implemet eeded correctios or modificatios. 9
V. ROADMAP FOR IMPROVEMENT 216 Use the data i this report for o-goig self-assessmet. Your AAAHC survey report icludes commets to explai ay PC or NC ratigs received by your orgaizatio. These should help you to idividualize the results of this overview report ad to bechmark your survey results. Here are some of the plas to address high-deficiecy themes i 216: Safe Ijectio Practices AAAHC will cotiue to parter with the Safe Ijectio Practices Coalitio ad to share these resources with our accredited orgaizatios. The Oe ad Oly Campaig website (http://www.cdc.gov/ijectiosafety/1aoly.html) icludes ifographics, toolkits ad videos amog other resources. Look for our 216 webiar offerigs ad Patiet Safety Toolkits to iclude this ad other ifectio prevetio ad cotrol topics. Credetialig, Privilegig ad Peer Review We have released two patiet safety toolkits addressig these issues i 215. Credetialig ad Privilegig, ad Peer Review ad Bechmarkig are relevat to all ambulatory health care settigs. Each is available o our website at www. aaahc.org/istitute/patiet-safety-toolkits. A webiar preseted i 215 o Peer Review ad Bechmarkig is still available for a limited time at www.aaahc.org/educatio/webiars/past-webiars. Quality Improvemet Illumiatig Quality Improvemet, a facilitator-led tool for movig from data collectio activities to meaigful QI studies was lauched at Achievig Accreditatio i December 214. It has bee exceptioally well received ad we will cotiue to use it i this cotext. As we look forward to 216, we are plaig to make it more widely available to our orgaizatios. Documetatio Most orgaizatios would beefit from coductig a comprehesive aual ispectio of documetatio. Specific items to address iclude: Routie chart review should esure that the records cotai complete iformatio. Do you have a EHR system that ca war you whe a record is icomplete? Who s reviewig goverig body (GB) miutes to make sure that they are complete ad cotai evidece of the GB determiatios? Who i the orgaizatio receives a copy of the AAAHC Hadbook ad checks the policies to make sure your orgaizatio remais compliat from year to year? Who esures that the maiteace logs are reviewed ad actio is take (ad documeted) whe ecessary? Whe you evaluate your emergecy drills, are you documetig your process correctios? Semiars Achievig Accreditatio is a comprehesive face-to-face program coverig Stadards ad special topics related to accreditatio. I 216, programs will be held i: March 18-19, Tampa, Florida Jue 1-11, Sa Diego, Califoria September, TBD December 2-3, Ecore at Wy Las Vegas, Nevada 1
AAAHC Newsletters Triagle Times is a quarterly prit publicatio set to all accredited orgaizatios ad by subscriptio request. Most issues iclude Stadard Bearer, a colum focused o the iterpretatio ad meaig of a idividual Stadard. Past issues ca be reviewed o the AAAHC website: www.aaahc.org/ews/ewsletters/ttimes/. Coectio is a bi-mothly e-ewsletter set o request to subscribers. Each issue focuses o a sigle topic related to improvig the quality of your ambulatory health care orgaizatio. Past issues ca be reviewed here: www.aaahc.org/ews/ ewsletters/coectio. AAAHC Istitute Resources Each December, the Berard A. Kersher Iovatios i Quality Improvemet Award is preseted to AAAHC-accredited orgaizatios for exemplary QI studies. Oe award is give for the best study by a surgical/procedural orgaizatio; aother is give for the outstadig work by a primary care orgaizatio. The awards are made at the Achievig Accreditatio with wiers presetig their work. Previous wiig studies are published i the aually updated Iovatios i Quality Improvemet Compedium, available for purchase at www.aaahc.org/istitute > Publicatios. Quality Improvemet Isights is a collectio of white papers o specific topics i the area of QI icludig bechmarkig. Usig Bechmarkig Measuremet to Improve Performace over Time is a whitepaper illustratig the use of bechmarkig withi a QI study. This resource is available free of charge o our website. Patiet Safety Toolkits address a variety of topics i surgical ad o-procedural settigs ad are released regularly. Ofte they are ispired by high-deficiecy Stadards. Each icludes a overview of the importace of the topic to ambulatory health care settigs, a review of published articles, ad oe or more tools that you ca put ito practice to improve performace i your orgaizatio. The complete list of toolkits ca be foud at www.aaahc.org/istitute/patiet-safety-toolkits1. 11
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