title: Patient safety and office-based anesthesia.
abstract: OBJECTIVE
  Office-based anesthesia is a new and growing subspecialty within ambulatory anesthesia. We examine major developments in office-based anesthesia and how patient safety can be maintained.
  
  
  RESULTS
  The emergence of office-based anesthesia as a subspecialty of ambulatory anesthesia is a result of economic and social factors, and is also due to the development of better surgical techniques and anesthestic drugs. There is still a dearth of primary literature that addresses patient safety in the office-based setting. Some existing literature points to increased risk in the office, although others suggest that proper provider credentialing, qualifications, and appropriate facility accreditation can improve patient outcomes compared to surgicenters and inpatient facilities. There is a lack of state and federal oversight of office-based facilities. Increased regulation and standardization of care, such as the use of check lists and professional society guidelines, can help promote safer practices.
  
  
  CONCLUSIONS
  There is no uniform standard of care for performing procedures in the office-based setting. Healthcare providers are facing the challenge of creating a safer, efficient, cost-effective and patient-centered environment. Available data show that the office-based practice can be as safe as any ambulatory surgicenter or hospital, as long as patients, regulators, and physicians become educated advocates of safer practices. In addition, procedures can be performed safely with general anesthesia or conscious sedation, provided that there are properly trained personnel and adequate equipment and facilities. Moreover, physicians should be credentialed to perform the same procedure in a hospital that they perform in an office.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. rurman@partners.org
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
authors.forename: Nathan
authors.initials: N
authors.lastname: Punwani
authors.forename: Fred E
authors.initials: FE
authors.lastname: Shapiro
mesh_terms: D000068:Accreditation; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D000758:Anesthesia / Q000009:adverse effects*; D016208:Databases, Factual; D006801:Humans; D007345:Insurance Claim Review; D061214:Patient Safety / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D058996:Quality Improvement; D017751:Safety Management / Q000331:legislation & jurisprudence / Q000379:methods* / Q000592:standards; D014481:United States