With the ever increasing number of outpatient surgeries coupled with advancement in technology for non-invasive procedures and shorter acting anesthetics, more and more patients are being treated at freestanding surgery facilities. However, the trend in patient co-morbities has also risen, increasing the risk of providing anesthesia even though the procedures are so-called "low-risk". This makes one wonder are the patients being treated in freestanding surgery facilities really sicker than they appear? And therefore is their patient safety at risk?
In this excerpt from her dissertation titled A Retrospective Study of A Gastroenterology Facility:Are The Patients Sicker, Kim Riviello DNP, MBA/HCM, CRNA, President of ASG, will discuss the concerns for patient safety in freestanding surgery facilities, despite the procedures being considered "low-risk".
There has been substantial growth in the number of ambulatory surgery centers across the United States. With the advancement in technology for non-invasive procedures, and shorter acting anesthetics, more patients are being seen in the freestanding surgery facility (FSF). However, the trend in patient co-morbidities, i.e., obesity, diabetes, cardiac, and respiratory diseases has also risen, increasing the anesthetic risk even though low risk procedures are performed. The most common malpractice claims have been associated with diagnostic procedures performed in ambulatory surgery centers under monitored anesthesia care (MAC) with patient co-morbidities as contributing factors. The morbidity and mortality of ambulatory surgery patients has led to an increased concern for patient safety in freestanding facilities. Of particular concern is sedation, specifically in gastroenterology (GI) centers. Yet, the Journal of the American Medical Association (JAMA) recently reported that two-thirds of the anesthesia procedures provided during colonoscopies and endoscopies (EGDs) were on “low-risk patients;” suggesting the lack of need for professionally administered anesthesia in GI facilities and implying that specialist monitored anesthesia would contribute to the increased cost of these procedures (Liu, Waxman, Main, & Mattke, 2012).
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