Association creates new standards for anesthesia
Association creates new standards for anesthesia
Accreditation offered for office anesthesiologists
Patients and health care organizations are now getting a benchmark for assessing office-based anesthesia organizations, thanks to recent action by the Skokie, Il-based Accreditation Association for Ambulatory Health Care Inc. (AAAHC).
In light of mounting concerns over safety issues related to the growing number of office-based surgical procedures, AAAHC announced it has become the nation’s first accrediting organization to develop quality standards for the accreditation of the so-called "office-based" or "mobile" anesthesia organizations providing on-site services for these procedures.
With an increasing number and variety of surgical procedures now taking place in doctors’ private offices, as opposed to hospitals or surgery centers, concern over patient safety issues is growing — on the part of the public and medical practitioners alike. Several recent high-profile tragedies were possibly, in part, caused by inadequate procedures for providing anesthesia in office-based settings. These include an 18-month-old boy who died during a routine MRI scan in a doctor’s office and a woman who died of respiratory failure from powerful sedatives remaining in her blood following breast augmentation surgery.
"The problem here is that while hospitals and surgery centers have long come under the purview of state-level oversight, doctor’s offices have fallen through the cracks’ of regulatory processes," says David Barinholtz, MD, president and CEO of Chicago-based Mobile Anesthesiologists. "There are really no hard-and-fast rules across the country regulating what can or cannot be done in a doctor’s office when it comes to surgical and anesthesia procedures." Indeed, he notes, "Only two states — California and New Jersey — have passed legislation bringing patients in doctors’ offices under the same blanket of protections as those in hospitals and surgical centers."
The problem is exacerbated by the increasing number of surgical procedures being performed in doctors’ offices, according to Barinholtz. "Ten years ago, office-based surgeries accounted for perhaps 1% of all surgeries, but by the year 2001 more than 20% of all surgical procedures will take place in doctors’ offices." Meanwhile, says Barinholtz, "48 of the 50 states in the United States don’t have the proper regulations in place to make sure that quality and safety are not suffering in these settings."
This lack of regulatory oversight extends to anesthesia procedures. As the variety of surgeries performed in doctor’s offices grows, so also does the number of procedures that require more than simple local anesthesia. And many doctors’ offices "don’t have the proper equipment and backup necessary for handling [anesthesia-related] emergencies," says Barinholtz. "If all you have in the office is a nurse and a plastic surgeon, for example," he says, "you really don’t have anyone on site who understands the complications of anesthesia." This type of situation is widespread, he adds, "and now exposes some 8 million people per year to risks that they don’t have to be exposed to."
Ensure safety by attention to quality
To address the concerns about anesthesia procedures undertaken in doctors’ offices, AAAHC has developed five new quality standards that will be applied, along with existing AAAHC criteria, to office-based/mobile (sometimes referred to as "itinerant") anesthesia organizations. (See AAAHC standards, at left.) These new standards are being added to the 1999 AAAHC Accredita tion Handbook, which contains the complete scope of quality standards that must be met in order to achieve accreditation.
The growing use of office-based anesthesiologists lends itself to the unique approach taken by AAAHC, according to Barinholtz. "Traditionally, accreditation has focused on institutions such as hospitals and surgery centers." But by accrediting office-based anesthesiology organizations that operate in doctor’s offices, "AAAHC holds them to the standard of making sure these doctors’ offices meet all its requirements before they will even set foot in the office," he says.
Barinholtz, along with Mark Koch, MD, president and CEO of Whitestone, NY-based Resource Anesthesiology Associates, assisted AAAHC in the development of these standards. Their two organizations are the first to receive accreditation under the standards, granted after a peer-based survey of their practices and procedures.
"Anesthesia practices in the office-based setting have been unchecked for too long," says Barinholtz. "We are dedicated to ensuring safety in the ambulatory environment and are pleased that AAAHC has established standards to help professionals in the field achieve this goal."
[For more information, contact:
• The American Association for Ambulatory Health Care, 9933 Lawler Ave., Skokie, Ill. 60077-3708. Telephone: (847) 676-9610. Fax: (847) 676-9628. Web site: www.aaahc.org.]
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