|
|
|
| |
The duties of the Committee on Ambulatory Surgical Care
are to:
1. Devise and review
standards for ambulatory surgical facilities as
they pertain to anesthesiology.
2. Develop and periodically review guidelines
for the practice of anesthesiology in ambulatory
surgical facilities.
3. Keep the membership informed of developments
in this field that are of significance to anesthesiologists.
4. Maintain liaison with other organizations in
this field.
|
Patient education is a cornerstone of safe, successful
ambulatory surgical care. This year the committee prepared
a revision of the patient information brochure, “Anesthesia
for Ambulatory Surgery,” with valuable input from
the Committee on Communications. A subcommittee led
by Walter G. Maurer, M.D., updated the material present
in the existing brochure and added sections on “Special
Considerations for Children” and on “Your
Rights as a Patient.” This revised brochure will
go into print in late 2002 and will appear on the ASA
Web site then.
The major issues in the ambulatory setting are maintaining
the quality of care and demonstrating this quality of
care to potential patients and to potential payers.
Many ambulatory facilities approach this by obtaining
accreditation. In the United States, three national
organizations are largely responsible for accrediting
ambulatory surgery facilities. These are the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO),
the Accreditation Association for Ambulatory Health
Care (AAAHC) and the American Association for Accreditation
of Ambulatory Surgery Facilities (AAAASF).
The committee represents the interests of anesthesiologists
at each of the three accrediting organizations, and
much is happening. ASA has representation on the JCAHO
Ambulatory Professional and Technical Advisory Committee
(PTAC), through our delegate Rebecca S. Twersky, M.D.,
and alternate Dr. Maurer. Additional anesthesiology
presence is provided through the Society for Ambulatory
Anesthesia (SAMBA) representatives Kathryn E. McGoldrick,
M.D., and alternate J. Lance Lichtor, M.D. In the past
year, topics that were addressed included medication
use standards as well as safety and error reduction
standards. In the near future, JCAHO is planning a revision
of all its standards in a step-wise fashion, for ambulatory
care as well as behavioral health care, home care, hospitals,
long-term care and laboratories. The objectives of this
intensive standards review are to generate fewer standards
requirements, clarification of standards requirements
and an attendant reduction in documentation requirements.
JCAHO expects that the product of this ambitious reorganization
will be implemented in January 2004. Also, JCAHO has
accepted the invitation to become a formal collaborative
member of the Leapfrog Group, a consortium of large
business health care consumers. The group’s focus
has been on improving patient safety and quality of
care and reducing medical errors.
Accreditation Association for Ambulatory Health
Care (AAAHC) is represented by ASA delegate
Jeffrey L. Apfelbaum, M.D., and alternate Thomas L.
Joas, M.D. SAMBA representatives are Beverly K. Philip,
M.D., and alternate Raafat S. Hannallah, M.D. AAAHC
is undergoing a major revision of the anesthesia standards.
Due to diligent efforts begun by past ASA representative
Dr. Twersky and continued by the present ASA and SAMBA
representatives, the AAAHC anesthesia standards are
consistent with ASA’s practice standards, guidelines
and statements. Issues addressed this year include the
qualifications and availability of the personnel responsible
for patient resuscitation. Personnel qualified in advanced
resuscitative techniques (e.g., advanced cardiac life
support or pediatric advanced life support) must be
present or immediately available until the patient has
been medically discharged. The standards committee is
working to develop a practical definition of what is
“immediately available” for resuscitation.
Also added was a requirement for the presence of second
qualified individual in addition to the operator when
a patient receives moderate sedation in addition to
deep sedation and general anesthesia. The AAAHC Standards
Committee and Board of Directors voted not to accept
recommendations for removal of the physician supervision
requirements.
AAAHC Institute for Quality Improvement subsidiary continues
to develop and publish best-practice performance measurement
initiatives. In the past year, it published “Knee
Arthroscopy and Meniscectomy 2001,” “Cataract
Extraction With Lens Insertion 2002” and “Asthma
Management in College Health.” Colonoscopy, student
health, patient satisfaction and two liposuction initiatives
are ongoing.
In 2002, AAAHC finalized a cooperative accreditation
agreement with JCAHO. Under this agreement, ambulatory
care components of organizations surveyed under JCAHO
are hospital-tailored, or network programs can use AAAHC
accreditation decisions to satisfy JCAHO accreditation
requirements. This option does not extend to hospital
outpatient services included under the hospital’s
Medicare provider number.
The AAAHC Office-Based Surgery Accreditation Program
is now active. AAAHC is also considering developing
a credentialing/privileging program for office-based
physician practices.
American Association for Accreditation of Ambulatory
Surgery Facilities (AAAASF) is represented
by Dr. Apfelbaum. New this year, the standards require
that the administering or supervising physician be physically
present in the operating room suite throughout the conduct
of all anesthetics. Also, the qualified physician who
is responsible for supervising the administration of
anesthesia must “demonstrate knowledge in anesthetics
and resuscitative techniques appropriate for the type
of anesthesia being administered.” This education
requirement parallels similar efforts in progress by
ASA in collaboration with the American College of Surgeons.
The Task Force on Office-Based Anesthesia
has responded to inquiries from ASA members regarding
office-based anesthesia standards, and regulatory initiatives
in their respective states. S. Diane Turpin, J.D., from
the ASA Washington Office further provides assistance
to members. The National Patient Safety Foundation convened
a workshop in June 2002 with Dr. Twersky representing
ASA. Several items for enhancing patient safety were
recommended with project completion expected within
the next 12 months. Committed to further expanding our
knowledge and education in this area, ASA conducted
a Workshop on Office-Based Anesthesia in July 2002 in
San Francisco. 
| |
|
Beverly
K. Philip, M.D., is Associate Professor of Anesthesia,
Harvard Medical School, and Director, Day Surgery
Unit, Brigham and Women’s Hospital, Boston,
Massachusetts. |
|
| |
|
Rebecca
S. Twersky, M.D., is Professor of Clinical Anesthesiology,
State University of New York (SUNY) Health Science
Center at Brooklyn, New York. |
|
|
return to top
|
|
|
|
|
FEATURES
Perioperative Medicine
ARTICLES
DEPARTMENTS
The views expressed herein are those of the authors and
do not necessarily represent or reflect the views, policies
or actions of the American Society of Anesthesiologists.
NL Archives
Information for Authors
|
| |
|
|