Standards of safety for office based anesthesia
Just as Ambulatory Surgery Centers (ASC) shifted the paradigm of outpatient surgeries with anesthesia in the mid 1990’s, Office Based Anesthesia (OBA) has continued the trend in current practice. Looking for a more cost efficient and convenient way to deliver patient-centric care is something that third party payors, surgeons and patients are all looking to further expand. But, from the anesthesia provider perspective, how does one maintain the safety standards similar to a hospital based setting?
Quality of Care:
The Society for Ambulatory Anesthesia (SAMBA) has created an Office Based Anesthesia Committee which explores particular issues related to administering anesthesia outside of a hospital or surgery center. There are many complicated nuances involved with delivering anesthesia in a remote location. It is now standard of care that the proceduralist (physician, dentist, etc) should NOT be providing the sedation and monitoring the patient, while performing the procedure itself. Having a separate individual/team to monitor the patient and provide sedation is imperative to minimizing complications. In addition to the experienced provider being appropriately trained and credentialed, the dedicated team member should be well versed in the Continuum of Sedation as provided by the American Society of Anesthesiologists.
Patient and Procedure Selection:
Being in a remote setting is just that- isolated and inaccessible. It is imperative for the anesthesia provider and procedure team to ensure appropriate communication, especially during emergent circumstances. Only appropriate patients who meet certain criteria should receive procedures in an office based setting. For an elective procedure, it is important that the patient be optimized from both their primary care and specialist physicians.
Facility and Safety:
The facility where the procedure is being performed should ensure that it is current with all safety federal, state and local codes and regulations. This includes policies and procedures in regard to medication storage and dispensing.
The anesthesia provider should adhere to a certain set of standards, including:
Basic Standards for Pre-anesthetic Care
Standards for Basic Anesthesia Monitoring
Standards of Post-anesthetic Monitoring
Guidelines for Ambulatory Anesthesia and Surgery
Equipment and Monitoring:
All equipment should be maintained and tested and should follow the ASA Standards. If providing pediatric care, the equipment should be appropriately sized for the patient.
Emergencies and Transfers:
All office based personnel should be appropriately trained in their respective roles for emergency management. An appropriate protocol should be in place to facilitate the necessity to transfer a patient to a higher acuity emergency location for further management.
Office Based Anesthesia is undoubtedly the new and emerging frontier for both procedures and anesthesia. However, with further isolation comes increased risk. The continued vigilance, attention to detail and understanding limitations are all important aspects of OBA.
At SmileMD, we keep safety as of utmost importance and at the forefront of all our interactions. We have been the safety experts and leaders in Office Based Anesthesia since inception.