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June 2000
Volume 64 |
Number 6
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SUBSPECIALTY NEWS
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| Anesthesia Patient
Safety Foundation and Office-Based Anesthesia |
Robert K. Stoelting, M.D., President,
Anesthesia Patient Safety Foundation
The Anesthesia Patient Safety Foundation (APSF), like ASA, believes
that office-based anesthesia (OBA) and surgery have become an
anesthesia patient safety issue. In this regard, the Spring 2000
issue of the APSF NEWSLETTER
is devoted to OBA. APSF is concerned that the explosive expansion
in OBA for an increasing number and variety of surgical procedures
has occurred without appropriate considerations for patient safety.
Newspaper reports and television documentaries have detailed tragic
and clearly avoidable adverse incidents occurring during anesthesia
and surgery in the physician's office. Of note, almost all of
these tragedies have involved anesthesia-related events.
It is inconsistent and illogical to perform an anesthetic or
a surgical operation in a physician's office without having the
same resources (personnel, equipment, monitors, drugs, facilities
and administrative policies) that would be present (and are required
for accreditation) for the same surgical procedure to be performed
in a hospital or ambulatory surgical facility. Sound reasoning
and logic dictate that patients should receive the same level
of anesthetic care regardless of the setting in which the surgery
is performed. Patients need to be assured that a single safety
standard applies regardless of whether anesthesia is delivered
in a physician's office, hospital or ambulatory surgical facility.
At present, OBA too often represents an "unregulated environment"
that lacks the infrastructure and safety net inherent in hospitals
and ambulatory surgical facilities.
Topics in the special OBA issue of the APSF NEWSLETTER
include "Office-Based Patient Safety: Definition of the Problem"
(Robert C. Morell, M.D.), "Update on Office-Based Anesthesia:
Standards, Regulations, Guidelines and Accreditation" (Rebecca
S. Twersky, M.D.), "Office-Based Anesthesia Regulations" (Ervin
Moss, M.D.), "Office-Based Anesthesia and Potential Liability"
(Sally T. Trombly, J.D.), "Strategies for Data Collection and
Analysis to Protect Patient Safety in Office-Based Anesthesia
and Surgery Settings" (David M. Gaba, M.D.) and "Questions I Would
Ask Before Agreeing to Office-Based Anesthesia" (Robert K. Stoelting,
M.D.).
Patients may erroneously assume that surgery and anesthesia
performed in the physician's office will be "identical" to that
in the traditional hospital operating room or ambulatory surgical
facility. But this may not be the case, and patients (the "public")
must be educated to ask the proper questions to assure the safety
of their individual experiences and to provide an incentive for
the establishment of a "single safety standard," regardless of
the site where surgery and anesthesia are performed. In this regard,
examples of questions that may be useful and informative for patients
to ask prior to consenting to a surgical procedure that requires
anesthesia in a physician's office include:
- Is your office accredited for performance of
surgery and administration of anesthesia?
- How many of these operations have you performed,
and would you have this operation in an office such as yours
if you were the patient?
- Are you credentialed to perform this operation
in a hospital or ambulatory surgical facility?
- Who will administer my anesthesia, and what are
his/her qualifications?
- Is the individual administering my anesthesia
credentialed to administer anesthesia in an accredited hospital
or ambulatory surgical facility?
- When will I meet the individual responsible for
administering my anesthesia?
- What are the choices available to me for anesthesia?
- Will the individual administering my anesthesia
be in constant attendance with me during my anesthetic?
- Will the anesthesia machine used for my anesthetic
be modern and equivalent to the machine that would be used if
I had this operation in a hospital or ambulatory surgical facility?
- Will the monitors used on me during my anesthetic be
the same that would be used if I had this operation in a hospital
or ambulatory surgical facility?
- Do you have necessary equipment and drugs to handle
any possible emergency that might occur during or following
my anesthetic?
- What hospital will I be admitted to should a complication
occur during my anesthetic?
- Is there a separate area where I will be taken to awake
from my anesthetic?
- What are the qualifications of the individual who will
monitor me in this recovery area?
- Will the monitors used during my recovery from anesthesia
be the same as would be used if I was recovering after surgery
in a hospital or ambulatory surgical facility?
- Is the recovery area in your office equipped in a similar
manner to the recovery area in a hospital or ambulatory surgery
facility?
- Who is responsible for determining if I am ready to
be discharged home?
- Who in your office is certified in advanced cardiac
life support (ACLS)?
It is the hope of the APSF that the OBA issue of the APSF
NEWSLETTER will serve as the "rallying point" for all those
involved in OBA and office-based surgery (patients, providers,
industry, insurance companies and accreditation agencies) to exert
a maximum effort for optimizing patient safety during OBA. In
this regard, increased public awareness of anesthesia patient
safety issues may be one of the most important determinants for
improving anesthesia patient safety during office-based anesthesia.
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