January 25, 2016 | | Comments 0
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Does closing rooms due to environmental conditions always make the best sense?

Every once in a while, someone asks me a question about why (or as is more the case here, “how”) a certain approach or response “becomes” the standard of practice, etc. For instance, a lot of times, I will find Interim Life Safety Measures policies that always seem to drive implementation, almost in direct opposition to the level of risk engendered by the deficiency (one caveat: I think you really have to tend towards over-implementing for construction and renovation activities, if only because you can have so little actual control over contractor behaviors. You need think only of the number of truly successful above the ceiling work permit processes—almost makes Powerball sound like a sure thing, but I digress). Anyways, to bring this back to today’s topic, I am reasonably certain (I was going to say “know,” but since I haven’t been everywhere) that many, many folks (very close to all) have intermittent struggles with the management of environmental conditions in surgical procedure areas. If we can use the number and type of Joint Commission findings as any indicator, the struggles continue.

I think we can operate under the assumption that there are very few surgical procedure areas that are perfectly configured every moment of every day (I don’t think that’s a stretch, but please let me know if you have found perfection in this regard). But what I see all the time are policies for which the response to out-of-range values (once you’re done with the call tree) is to make the decision to continue with cases or to close the rooms until the conditions can be resolved. Now I know there are instances in which you need to be a little more careful; I can see the risks of continuing with an invasive surgical procedure if your air pressure relationships are bit squirrelly. But what about the actual risks associated with out-of-range temperature and/or humidity? I mean, if you have an upper humidity limit of 60% (which I think is fairly common), a condition of 60.1% RH is an out-of-range value, but I don’t see where it would necessitate closing the room, delaying cases, etc.

I did a little poking around to figure out the genesis of the “closing the room” dynamic and I have been unable to make anything close to a real determination of where this started. Anecdotally, I got some indication that CMS was the perpetrator, but I’ve heard the same thing about CMS and the general prohibition of cardboard, so I think this may very well reside in that vast wasteland of healthcare compliance mythology (and no Mythbusters to tackle these pressing issues—bugger!). At any rate, I’m wondering if anyone out there has really analyzed the increasing/decreasing risk factors relative to out-of-range (low and/or high) humidity or temperature conditions. I can’t help but thinking that we can do better in this regard, so if someone has something to share (perhaps this would be a very good improvement project for 2016). There’s got to be a point where the risk of the environmental condition(s) actually outweighs the risk of delaying treatment/procedures, etc. Maybe it’s time to figure out exactly where those tipping points live…

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Filed Under: CMSEnvironment of careThe Joint Commission

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at stevemacsafetyspace@gmail.com.

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