Ambulatory Surgery Centers (ASCs) are increasingly becoming the preferred setting for many surgical procedures due to their lower costs and convenience compared to traditional hospitals. Today, more than 80% of surgeries are now performed in an outpatient setting, but ASCs are not without their own set of risks. As the complexity of procedures performed in ASCs increases and patients are being discharged quicker than ever before, it is crucial to conduct thorough assessments to identify potential concerns such as obstructive sleep apnea or cardiovascular disease which could lead to complications during or after surgery. There are certain patient characteristics associated with more frequent adverse events, including:
- Existing health issues, particularly obstructive sleep apnea
- Advanced age
- History of healthcare utilization
- Minority race or ethnicity
- Access to care and distance to treatment facilities
The Rising Cost of Errors
Recent years have seen a rise in “nuclear verdicts” – jury awards exceeding $10 million – in lawsuits against ASCs. These verdicts highlight the potential for significant financial consequences when things go wrong in an ASC setting. One example is an ongoing case where a plaintiff’s lawyer is arguing for $50 million in compensation in a medical malpractice lawsuit for damages surrounding a colonoscopy performed at an ASC. According to the report, the allegations include anesthesia and surgical errors, and wrong choice of surgery setting as the patient suffered from hypertension and sleep apnea. Another notable case with a large payout involves a 55-year-old man who underwent outpatient shoulder surgery at an ASC. According to the report, the anesthesiologist failed to maintain adequate blood pressure levels during the surgery, which resulted in a stroke for the patient and a $1.1 million settlement on his behalf.
Enhancing Patient Safety in ASCs
To improve patient safety and reduce the risk of complications in ASCs, the following strategies are recommended:
- Standardized Pre-Op Assessments: Implement a comprehensive standardized pre-operative assessment. It is important for a diverse team comprised of multiple disciplines such as anesthesiologists, nurses, social workers and surgeons evaluate patient suitability for surgery.
- Post-Op Monitoring: Conduct regular, timed post-operative assessments and promptly address any worsening patient condition.
- Standardized Checklists: Utilize standardized checklists to ensure proper intraoperative equipment is readily available and can be adjusted for specific patient needs (e.g., supplies for difficult airway management).
- Safety Culture: Foster an environment where employees feel empowered to speak up about potential safety issues through Safety Culture Training.
- Regular Emergency Drills: Train employees to respond to emergencies like respiratory distress, strokes, cardiac issues, surgical fires, patient falls, malignant hyperthermia and hemorrhage through frequent and realistic drills.
- Staff Training: Ensure all staff receive Basic Life Support (BLS) training, with applicable clinical staff receiving Advanced Cardiac Life Support (ACLS) training, and Pediatric Advanced Life Support (PALS) training for those caring for pediatric patients.
- Informed Consent: Ensure all elements of informed consent including risks, benefits, anesthesia, and alternatives and goals of the procedure are thoroughly explained, documented and signed by the patient or legal representative, ideally before the surgery date.
Additional Resources on ASC Safety Best Practices
Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea – To decrease risks specifically for patients with sleep apnea, review this guide from the American Society of Anesthesiology.
Ambulatory Surgery Center Association (ASCA) – Resource center for ambulatory surgery professionals.
Reach Out to an Advisor
Our risk professionals can provide tailored recommendations to help your ASC mitigate legal risks, enhance patient safety and improve operational efficiency. Contact us to learn more.