Building Safety Nets for Surgery in the Medical Office

Surgery in the medical office setting can confer benefits for both the physician and the patient, as it can control costs, allow for flexibility in scheduling, and increase overall convenience. As such, the prevalence of obstetric and gynecological surgical procedures being performed in the office setting has increased. Now, clinicians perform anything from infertility treatments and simple vulvar biopsies to hysteroscopies, D&C procedures and endometrial ablation-even though there are no regulations guiding patient safety principles for these increasingly complex procedures. So how does a clinician ensure good outcomes?

We invited Dr Bruce Ettinger, investigator and medical consultant in the Health Facilities Inspection Division of the Los Angeles County Department of Public Health, to share some insights and guidance for clinicians who wish to perform surgical procedures in their offices. As a consultant, Dr Ettinger evaluates issues in care quality and safety in ambulatory care and hospital settings, and has explored these issues as they pertain to the ob/gyn office setting in a poster presented at the American Congress of Obstetricians and Gynecologists’s annual meeting. Dr Ettinger is also board certified in obstetrics and gynecology and, before moving into his current role, had more than 35 years in clinical practice.

Take-Home Tips:

• Play the role of the investigator: look for and address issues and potential problems to prevent adverse events.

• Use government resources as a guide; see California’s State Manual, Guidance for Surveyors, Ambulatory Surgical Centers at http://www.cms.gov/manuals/Downloads/som107ap_l_ambulatory.pdf.

• Infection control is a critical issue; check online journals for tips on management.

• Create and use benchmarks and best practices. Use checklists and standardize everything.

• Consider dedicating one day for procedures so the entire office is focusing on the safety and success of in-office surgical procedures.

• Don’t go it alone. Talk with colleagues, develop networks and supports.

• Think ahead. Plan ahead.