Anesthesiology clinics
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Anesthesiology clinics · Mar 2009
Anesthesia in the cardiac catheterization laboratory and electrophysiology laboratory.
Procedures and interventions in the cardiac catheterization laboratory (CCL) and electrophysiology laboratory (EPL) are more complex and involve acutely ill patients. Safely caring for this growing patient population in the CCL and EPL is now a concern for all anesthesiologists and cardiologists. Anesthesiologists are uniquely trained to care for this complex patient population, allowing the cardiologist to focus on completing the interventional procedure successfully.
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Performing an anesthetic in a procedure suite instead of in the operating room can be extremely challenging for the anesthetist. Not only are the procedures performed outside of the operating room becoming increasingly more complex but also patient acuity is increasing. In some cases, the out-of-operating room procedure may be selected as a less risky alternative to an operating room procedure in an extremely high-risk patient. Effective preprocedure evaluation and preparation are critical to achieve optimal clinical outcomes and maximal operational efficiency in these areas.
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The safety of anesthesia delivered in the operating room is enhanced by the standardization and reliability built into that environment, which has prescriptive and detailed protocols for almost every procedure performed. Experienced anesthesiologists come to rely on these operating room characteristics to support the delivery of safe care. Anesthesiologists giving anesthesia outside the operating room often find themselves in settings that lack this rigor and that therefore challenge safety. This article describes the basic concepts in safety, with an emphasis on teamwork and communication, and then discusses how their application ensures safe care in remote locations.
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There is no need to reinvent the wheel to determine the need for vigilant monitoring in outside of the operating room (OOR) settings. Anesthesiologists have evolved a robust system of monitoring standards based on decades of experience in operating room environments. Every OOR location should be thoroughly evaluated and monitoring standards implemented. The standards should be periodically reviewed to avert morbidity.
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Anesthesiology clinics · Mar 2009
Traditional fee-for-service Medicare payment systems and fragmented patient care: the backdrop for non-operating room procedures and anesthesia services.
Achieving fundamental reform of the health care system to improve patient outcomes will take decades of effort and a major shift in financial, medical, and political behaviors that have built up since the beginning of health insurance in the United States. To the extent that the present payment systems contribute to the high cost, poor quality, and lack of accountability that characterizes today's health care delivery system, there is hope that reforms are within reach.