Preventing Anesthesia Complications Starts in Pre-op

Better pre-op assessments by anesthesia providers could significantly reduce the number of anesthesia-related injuries they see, according to an analysis of closed claims data by a national malpractice insurer.

Inadequate pre-operative assessments were a factor in 15% of cases filed against anesthesia professionals, says co-author Darrell Ranum, JD, CPHRM, vice president of patient safety at The Doctors Company. "Knowledge of patient history, comorbidities, chronic conditions and current status is essential for planning appropriate anesthetic treatment and critical for anticipating [surgical] complications."

The analysis also found that, despite having had anesthesia-related risks explained to them, many patients who filed claims didn't fully understand those risks or associate their injuries with anesthesia. "The results … show how important it is for physicians to communicate with patients … and to link informed consent discussions with the complication that they experienced," says co-author Richard D. Urman, MD, assistant professor of anesthesia at Harvard Medical School and a staff anesthesiologist at the Brigham and Women's Hospital in Boston, Mass.

Of 607 claims analyzed, the most frequent injuries were tooth damage (20.8%), death (18.3%), nerve damage (13.5%), organ damage (12.7%), pain (10.9%) and arrest (10.7%). Obesity was the most frequently identified contributing factor.

Also of note: Ambulatory surgery centers had the lowest death-to-claim rate (12%). The average indemnity per claim was $309,066. And delayed responses to deteriorating vital signs were sometimes the result of ignored or disabled alarms.

Jim Burger

New Colonoscopy Prepping Guidelines Released

Split-dosing is the standard of care in colonoscopy bowel prepping, according to new multi-society guidelines, which also raise expectations for ensuring that patients present for screenings with adequate preps in place.

A committee of representatives from the American Gastroenterological Association, American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy jointly published the guidelines in the October issues of the American Journal of Gastroenterology, Gastrointestinal Endoscopy, and Gastroenterology.

The first dose should be taken the evening before the procedure, he explains, and the second the morning of the screening, beginning 4 to 6 hours before the colonoscopy start time and completed within 2 hours of the exam.

"The committee stated overwhelmingly that split-prepping is the standard of care and should be done routinely," says David Johnson, MD, lead author of the new guidelines and professor of medicine and chief of gastroenterology at Eastern Virginia Medical School in Norfolk. "Split-dosing leads to a better prep and increases patients' willingness to undergo screening again."

Inadequate preps should be determined very quickly, according to Dr. Johnson. "Aborting the exam is not subject to salvage strategy," he says. "Cancelled exams should be repeated within a year. That's new. A number of studies have suggested 3 years, particularly for patients with adenomas."

The committee also reassessed the definition of successful preps. Dr. Johnson says approximately 75% of preps are adequate, but the new guidelines increase the minimal threshold to 85%. He believes this new measurement will get some traction as the national societies look to new benchmarking technology to measure and evaluate the quality of colonoscopy exams.

Patients need to clearly understand prepping guidelines, the importance of following them and why prepping is so critical to quality exams, says Dr. Johnson, who added that physicians will be expected to maintain the new level of successful in practice.

"Really, successful preps should be achieved more than 85% of the time. Everyone is going to be accountable to that threshold, so be ready," he says. "We frequently hear physicians say patients didn't take the prep. But it's not just the patient's problem."

Daniel Cook

OR Excellence Pictures: Check Out Our New Orleans Slideshow

In its sixth year, Outpatient Surgery Magazine's OR Excellence conference drew a record crowd of surgical facility leaders to New Orleans earlier this month for 4 days of expert speakers, interactive education and networking — lots and lots of networking — with professional peers and vendors.

OR Excellence bills itself as surgery's most interactive, most informative and friendliest conference, something that's readily apparent in this slideshow of photos taken during the days' presentations and the nights' wine-tasting and martini-madness events in the exhibit hall.

Plan to join us in San Antonio, Texas, from Oct.13 to 16, for OR Excellence 2015.

David Bernard

InstaPoll: Are You Prepared to Receive an Ebola Patient?

As surgery centers, hospitals and healthcare systems across the country evaluate their infection prevention practices for Ebola safety, we want to know how prepared your facility is to receive an infected patient. Tell us in this week's InstaPoll, then check back next week for the results.

Last week we asked if you use the same surgical skin marker on more than one patient. Our 447 respondents were split right down the middle when it comes to concerns about skin markers being a potential source of cross-contamination. The results:

Do you reuse surgical skin markers?

  • Yes 50%
  • No 50%

Dan O'Connor

News & Notes
  • SSI risk greater for Medicaid spine patients Of patients undergoing spinal surgery, those insured by Medicaid suffered a higher surgical site infection rate after their procedures than those who were privately insured, according to a study published in the journal Spine. Researchers examined a database of spinal surgery patients to find the publicly insured were more than two times as likely to contract post-op infections.
  • Outpatient hip replacement is economical choice There is no difference in the incidence of complications between total hip arthroplasties done outpatient and those done inpatient, and the outpatient cases can cost much less, says a recent study, which calculated the average cost of an outpatient hip procedure at $24,529, as compared to inpatient's $31,327.
  • Anesthesia answers and advice, a website developed by Huntsville, Ala., anesthesiologist William Hass, MD, MBA, aims to improve providers' and practices' performance through the creation of a community for asking questions and sharing advice. "The answers to anesthesia service problems are readily available," the site says. "The real issue is the management, leadership, and governance of anesthesia services."