This falls in line with what we know about non-hospital, anesthesia-
related medical malpractice claims. One analysis of more than 3,300
closed claims in an ASA database shows that the median payment per
claim is $210,000 for events occurring in the OR and $330,000 for claims
occurring outside of the OR, including PACU or an endo suite
(osmag.net/FadBW5). In claims involving areas outside of the OR, the
study found that most took place in a gastrointestinal suite during mon-
itored anesthesia care (32%). These numbers are a good reminder that
not only can adverse events occur outside of the OR, but also that these
incidents can trigger a costly lawsuit for your facility.
Follow highest standards of care. The standards of the
American Association for Accreditation of Ambulatory Surgery
Facilities (AAAASF), the agency that accredited Yorkville Endoscopy,
and the ASA differ in one key area that greatly impacted the Rivers case:
what you're required to monitor. The AAAASF standard requires oxygen
saturation monitoring by pulse oximetry, which provides a very late indi-
cator of hypoventilation. ASA standards provide an extra level of safety
by requiring you to monitor the adequacy of ventilation in addition to
oxygenation. ASA standards call for the "continual observation of quali-
tative clinical signs and monitoring for the presence of exhaled carbon
dioxide." Although you may be a clinician, thinking like a lawyer could
keep you out of a lawsuit. If you were a lawyer defending an outpatient
surgery center like the one Joan Rivers was stricken in, would you pre-
fer that center to have used the AAAASF's standard or ASA's? (See
"AAAASF Defends Anesthesia Monitoring Standards.")
Closely monitor sedated patients. The Rivers case highlights the
importance of monitoring sedated patients. As a matter of policy,
you should monitor the respiration rate, oxygen and sedation levels of
all patients who receive any type of sedative, whether it's opioids in
PACU after a knee replacement or propofol for an endoscopy.
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