BLOG: Educating surgeons about office-based surgery accreditation eases safety concerns
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Key takeaways:
- Accreditation is important for office-based surgery to be viewed as a safe and viable option.
- Data have shown that office-based surgery offers the same level of safety as hospitals and ASCs.
As cataract volumes continue to grow, there is growing interest in office-based surgery.
My iOR colleagues and I were initially dedicated specifically to helping ophthalmologists navigate the complexities of adding cataract surgery to an office-based surgery (OBS) suite to their practice, but as our efforts expanded, we have become a source of information for surgeons and administrators from other specialties who — like ophthalmologists — are attracted to the cost savings and convenience inherent in the OBS model. Disseminating education about OBS and reassuring stakeholders that OBS suites are bona fide operating rooms that follow the accreditation standards of the same organizations and maintain the same safety standards as ASCs is a key mandate of iOR Partners, as it takes on the mantle of de facto OBS champion.
Just like ophthalmic surgeons, specialists in other fields are primarily concerned with safety. They want an unequivocal answer to this question: “If I add an OBS suite to my practice, can I be sure that my patients will experience the same level of safety that they would in an ASC or hospital?” We have a substantial body of real-world data that enables us to affirmatively answer that question. As I previously reported here, a recently submitted study that evaluated case records of more than 18,000 consecutive patients who underwent office-based lens surgery for visually significant cataract, refractive lens exchange or phakic IOL implantation, at 36 participating U.S. sites, found that office-based lens surgery can be performed safely, with adverse event rates similar to or lower than those in the published literature. Lance Kugler, MD, presented on more than 30,000 consecutive cases at the recent American Society of Cataract and Refractive Surgery meeting, and that includes not only IOL procedures but also glaucoma, retina, cornea and oculoplastics cases performed safely in 49 iOR suites.
In addition to publishing data, sharing information about the accreditation standards to which OBS is held is one way that we are able to broadly educate surgeons and administrators, across numerous specialties, about the safety and efficacy associated with this practice model. Working to ensure that accreditation standards are established and maintained is part of what iOR does when we assist with the addition of an OBS suite. The company establishes and maintains ongoing compliance to ensure each OBS meets acceptable accreditation standards in accordance with approved third-party accreditation agencies and state and federal regulations. This includes but is not limited to performing ongoing quality assurance and performance improvement; initiating safety and risk assessment programs; generating outcomes reporting; determining and tracking benchmarks; and performing periodic audits.
OBS suites follow the same safety standards as ASCs and hospitals and are regulated in all 50 states. They operate under the physician’s license governed by the individual state board of medicine using either Class A (oral sedation) — which is the most common method used for most of our lens surgery patients today — or Class B (monitored) anesthesia. We don’t currently offer Class C or Class C-M anesthesia in office-based suites. Essentially, ophthalmic OBS suites are accredited to the anesthesia standards that surgeons use and are accredited to the safety standards equivalent to those used by ASCs.
In the study that demonstrated that OBS lens surgery is as safe as — or safer than — lens surgery reported in the literature, patient selection was based on the American Society of Anesthesiologists (ASA) physical status classification system. Patients classified as ASA I and II were deemed adequate for surgery at an office-based facility. Patients classified as ASA III were selected for surgery on a case-by-case basis according to the physician’s discretion. Patients with an ASA IV classification were deemed inappropriate for office-based surgery.
If you have an accredited OBS, you are following the safety guidelines established by the accreditation organization that oversees your governance, quality programs, all of your case reviews, unanticipated sequalae and incident reports, among other things. We strongly believe that the future of safe and effective office-based ophthalmic surgery is based on following the accreditation standards that already exist with the Joint Commission and Quad A. We are not reinventing the wheel. We’re going with things that are already there.
Accreditation fosters a culture of quality and safety and remains a cornerstone for ensuring a consistent level of safe and effective care. As OBS becomes an increasingly familiar and viable option for ophthalmic surgery — and other specialties — accreditation acts as a powerful tool to assure patients that they are in good hands.
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