Out-Patient And Office-Based Surgery Center Safety

Surgery Center
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In the “good old days” surgeries were performed in hospitals and patients were kept for several days for observation. Now, all but the most major and complex of surgical procedures seem to be performed as “day surgeries” at out-patient surgery centers. Often, patients are released within hours of major surgery.

I’ll have to tell a little story on myself. I recently took my 18-year-old son in to have his wisdom teeth extracted. Being a med mal lawyer, I researched until I found one of the best oral surgeons in Dallas. I knew he would provide the best care possible for my son and I wasn’t really concerned, after all it was a quick and simple procedure. However, I couldn’t help myself. As we showed up on the day of the procedure, I asked the following questions:

What drugs will you be using for sedation? Propofol. Oh, will you be using qualitative end tidal Co2 monitoring? Yes. Good, because you know what I do for a living and I am sure you also know that all throughout Texas and elsewhere doctors are sedating patients without the necessary safety monitoring. Yes, I know and I have pushed for reform in this area because patients do run into complications and we can’t predict which ones will and which ones won’t, so we prepare for the worst. Yes, I know too because I have several cases I am working on right now for families of patients who went in for super minor procedures and either came out brain damaged or dead. I can only imagine and I guess you heard that there was a kid who died during wisdom teeth removal here in Dallas recently. NO, I hadn’t heard. OMG!

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So as to not leave you hanging, my 6’3” child was just fine and will now be going off to college with four less teeth, but completely unscathed from the procedure!

In the “good old days” surgeries were performed in hospitals and patients were kept for several days for observation. Now, all but the most major and complex of surgical procedures seem to be performed as “day surgeries” at out- patient surgery centers. Often, patients are released within hours of major surgery.

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SAFETY CONCERNS CENTER AROUND FIVE MAIN ISSUES

No. 1: The underlying health of the patient. Doctors will tell you that you could line up 100 people of all ages, sizes, health conditions and be unable to predict which patient would actually suffer a complication. Having said that, there are certain patients who are at high risk and should not be operated on in a facility which cannot promptly and completely respond to a life-threatening complication.

No. 2: The complexity of the surgical procedure. Generally speaking, very long and very complex procedures should be performed in a hospital that specializes in performing those procedures

No. 3: The depth of anesthesia. Often, even simple procedures are performed under general anesthesia, which carries its own set of risks. For example, have you ever had to sign an anesthesia risk disclosure form? You will see that whenever you are” put under”, you have to literally sign your life away, yet every day in the U.S. patients are being put “under” without the properly trained staff or equipment to rescue them if necessary.

No. 4: The training and equipment of the surgery team to respond to emergencies. If you or a loved one have had surgery at an “out-patient” center, would you be surprised to know that in some cases, the rescue plan for medical emergencies is to call 911? Yes, it happens and in the time it takes an ambulance to get to the surgery center, get the patient and take them to a hospital can result in severe brain damage and death.

No. 5: The premature discharge of patients. I am sure that all of you can relate to the feeling of being rushed out of an out-patient surgery center with a half conscious person in your charge! It’s scary! Usually, everything works out, but in some instances, the patient may have sustained an intra-operative or post-operative complication that could not possibly be recognized by family members who are lay persons and only if the patient was kept and monitored would the complication be caught in time to save the patient.

We must rely on physicians to always place patient safety first! In our everyday lives we feel comforted by the words “it is only a minor procedure” or “it is only day surgery,” but this must be balanced with a healthy respect for the potential catastrophes that can and do occur. Regulation and accreditation continue to be important aspects to ensuring patient safety, but there may also need to be a greater push for monitoring compliance and enforcing violations. Kay Van Wey 

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