Risk Management Plan
Helpm31990
Chapter17.pptxChapter 17: Risk Management in Office Based Surgery
Office Base Surgery (OBS)
Invasive procedures requiring general anesthesia and deep or moderate sedation which are performed in a doctor’s office separate from a hospital or ambulatory surgery center (ASC).
Technological advances and economic incentives led to a shift from hospital to ASC and now to office based surgeries.
Decrease in invasiveness of surgical procedures
Decrease in invasiveness of anesthesia
Concerns with OBS
Safety and ease of a procedure may entice physician to perform procedures they are not familiar with
Regulation of OBS is voluntary though is mandated in some states
As CMS did not allow facilities fees for procedures performed in OBS, they did not participate in regulating OBS practice as was done with other emerging healthcare entities
Sources of Risk in OBS
Informed Consent and Breach of Contract
Bleeding, Thromboembolism and Infections
Perforation of Viscus and Drug Toxicity
Interference with Pacemakers
Anesthetic Complications
Infection Control
Preexisting Condition Complications
Incorrect surgical procedure
Unplanned hospital admission from complications
Death
Legal Requirements for OBS Practices
Naming Designation
Corporate Designation
Referrals
Contracts between physicians and hospitals
Other Requirements
Some states require OBS to follow ASC regulations while others have established OBS specific regulations. In general OBS should:
Seek accreditation
Follow personnel requirements for education, training, licensing, board certification, hospital privileges and scope of practice
Select appropriate procedures to perform
Track and report adverse events
Accreditation and Clinical Guidelines
Currently there are 3 accrediting organizations for OBS facilities with very similar standards:
AAAHC
AAAASF
TJC
Clinical Practice Guidelines developed by professional associations should be adopted by the OBS as applicable
Management Practices
OBS facilities should have effective and efficient management practices in the following areas:
Personnel Management
Facility Management
Medical Records Management
Quality Management
Communications with patients
Clinical Practice Safety
OBS facilities should have effective and efficient clinical practice safety in the following areas:
Preoperative Practices
Intraoperative Practices
Postoperative Practices
Summary
The number OBS facilities continue to grow due to satisfaction of patients and practitioners
Risk management is an important consideration for the OBS facility as ease and safety of procedures may lead towards inappropriate selection of services
