Outpatient Surgery Magazine

Compounding Disaster - July 2016 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://outpatientsurgery.uberflip.com/i/703764

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Page 26 of 168

This falls in line with what we know about non-hospital, anesthesia- related medical malpractice claims. One analysis of more than 3,300 closed claims in an ASA database shows that the median payment per claim is $210,000 for events occurring in the OR and $330,000 for claims occurring outside of the OR, including PACU or an endo suite (osmag.net/FadBW5). In claims involving areas outside of the OR, the study found that most took place in a gastrointestinal suite during mon- itored anesthesia care (32%). These numbers are a good reminder that not only can adverse events occur outside of the OR, but also that these incidents can trigger a costly lawsuit for your facility. Follow highest standards of care. The standards of the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the agency that accredited Yorkville Endoscopy, and the ASA differ in one key area that greatly impacted the Rivers case: what you're required to monitor. The AAAASF standard requires oxygen saturation monitoring by pulse oximetry, which provides a very late indi- cator of hypoventilation. ASA standards provide an extra level of safety by requiring you to monitor the adequacy of ventilation in addition to oxygenation. ASA standards call for the "continual observation of quali- tative clinical signs and monitoring for the presence of exhaled carbon dioxide." Although you may be a clinician, thinking like a lawyer could keep you out of a lawsuit. If you were a lawyer defending an outpatient surgery center like the one Joan Rivers was stricken in, would you pre- fer that center to have used the AAAASF's standard or ASA's? (See "AAAASF Defends Anesthesia Monitoring Standards.") Closely monitor sedated patients. The Rivers case highlights the importance of monitoring sedated patients. As a matter of policy, you should monitor the respiration rate, oxygen and sedation levels of all patients who receive any type of sedative, whether it's opioids in PACU after a knee replacement or propofol for an endoscopy. 3 4 J U l y 2 0 1 6 • O U T PA T I E N TS U R G E R Y. N E T • 2 7

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