Features  |   May 2014
Ambulatory Surgery and Anesthesia: Creating a Culture of Safety in a Cost-Effective, Quality-Conscious Environment
Author Affiliations
  • Fred E. Shapiro, D.O.
    Chair, Committee on Patient Safety and Education
Article Information
Ambulatory Anesthesia / Patient Safety / Quality Improvement / Features
Features   |   May 2014
Ambulatory Surgery and Anesthesia: Creating a Culture of Safety in a Cost-Effective, Quality-Conscious Environment
ASA Monitor 05 2014, Vol.78, 12-15.
ASA Monitor 05 2014, Vol.78, 12-15.
In recent years, the economic realities of health care reimbursement and a growing consumer demand have lead to a dramatic shift in the way health care is delivered: from in-hospital O.R. settings, to remote interventional settings outside of the O.R., to outpatient facilities, and to physicians’ offices.
Significant safety issues related to the ambulatory procedural and surgical setting have been identified, including patient and procedure selection, perioperative care, management of complications and patient recovery. Other non-patient-related issues recently highlighted in both academic and popular literature include unqualified proceduralists performing procedures outside of their scope of practice, substandard facilities and lack of qualified personnel. These deficiencies have gradually attracted the attention of the Centers for Medicare & Medicaid Services (CMS), state health departments, medical boards, commercial health insurers and accreditation agencies. The Department of Health and Human Services (HHS), in collaboration with CMS, developed the idea of “value-based purchasing” (VBP), a construct for health care incorporating the National Quality Strategy and Agency for Healthcare Research & Quality (AHRQ) aims for the provision of health care that is both high-quality and cost-effective. Thus the National Quality Strategy goals focus on health care that is patient-centered, reliable, accessible, safe, and efficient while demonstrating reduced costs.
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