Patient Safety and Quality for Office-Based Procedures in Otolaryngology

https://doi.org/10.1016/j.otc.2018.08.015Get rights and content

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Key points

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    Before performing an office-based procedure, judicious evaluation of patient and procedure risk factors should be completed, and a detailed procedure-specific informed consent should be obtained.

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    Measures to prepare for emergencies include team role assignments and routine simulations, crash cart maintenance, and medication inventory.

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    Most common and impactful procedure-related complications can include wrong site/side of surgery, airway obstruction, bleeding, and vasovagal syncope.

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    Postprocedure

Patient and Procedure Selection

The most critical decision in this process is the judicious selection of which patients and what procedures are safe and appropriate to be done in an office setting. An oversight or error in this process can result in unintended complications and patient harm. The current health care environment has incentivized performing higher-risk procedures on higher risks patients in office-based settings without many protective regulations on patient safety and quality.5 Patient selection starts with a

Sterile Technique

Hospital and ASC settings have established protocols for infection control, sterility, and patient preparation before surgical intervention to minimize risks of nosocomial and postoperative infections. The expansive range of office-based procedures within Otolaryngology creates a wide potential for infection risk, therefore necessitating the appropriate level of aseptic technique for each procedure by the provider.13 When hands are visibly soiled, soap and water should be used initially, and

Recovery

The process of postoperative monitoring after a surgery is streamlined and inherent in the culture of hospitals and ASCs but not necessarily in the office setting. Because most office-based procedures are performed without general anesthesia or sedation, the need for postprocedure monitoring is not as evident, but patients should be evaluated after completion of any procedure to ensure their safe departure from the office. After completion of the procedure, an assessment should be performed by

Summary

Several proactive measures and preventative strategies can be implemented by Otolaryngologists to optimize patient outcomes and minimize the risk of procedure complications in the office setting. Developing a proficiency and comfort level with office-based procedures will become increasingly more important as the market forces are driving this shift within the rapidly changing world of health care. The systems that enhance patient safety and quality within hospital systems will need to be

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    • Disclosure Statement: The author has no financial relationship with any commercial entity or any conflict of interest with the subject matter presented in this article.

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