Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management最新文献

Office-based surgery (OBS) has emerged as a significant subspecialty of ambulatory surgery. There are few clinical trials and limited published data on patient characteristics, anesthesia, or outcomes distinguishing OBS from ambulatory surgery centers (ASCs). We examined retrospective data from a large mobile anesthesia practice for 89,999 procedures from 2016 to 2019. Data was abstracted from billing and an anesthesia-specific electronic medical record, segregating procedures performed in ASCs versus OBS. The number and breadth of procedures increased substantially. Compared to ASCs, OBS patients were more likely male (52% vs. 48%), older (61 years vs. 55 years), and to have a higher American Society of Anesthesiologists (ASAs) status (33% vs. 20% ASA 3 or higher). The procedure mix varied substantially between the two settings. The major complication rate was 0.07% for the ASCs and 0.24% for OBS (p = 0.2, confidence interval [CI] −0.15 to 0.04). Minor complications were 11.2% in OBS versus 17.3% the ASCs (p < 0.0001, 95% CI 5.2–7). The practice demonstrates a low rate of complications, and despite the limitations of this study, the organization and structure of this large mobile anesthesia practice serves as a template for effective risk mitigation and patient safety.

Incorrect assessment of the performance shaping factors (PSFs), especially in health care systems, may lead to irreversible consequences such as death. The current study aimed to adapt PSFs taxonomy given in standardized plant analysis risk human reliability analysis (SPAR-H) technique to surgical context. PSFs taxonomy of the SPAR-H technique was revised, and more contextspecific definitions to surgical context were suggested. Step-wise weight assessment ratio analysis (SWARA) and eleven-digit numerical scale were used for quantification of the weight and negative influence rate of the PSFs during surgical processes, respectively. Nine PSFs were proposed following the SPAR-H taxonomy. The order of the importance of the PSFs was quietly conflicting in terms of weight and negative influence rate. From the perspective of experts, fatigue and threat stress were assessed as the most important PSFs in terms of both weight and negative influence rate. Current study has offered a domain-based understanding of the PSFs, particularly in the surgical context. Results of this study could be used to evaluate human error behaviors during the performance of tasks in the operating room. Moreover, these results could be used for improving patient safety programs in health care systems.

Just as the general population of the United States is aging, so, too, is the population of active physicians. Training to become a physician and practice medicine is an arduous process. The competition to gain admission to medical school is fierce, the price tag of medical education is high, and waiting to learn about matching to a residency program is stressful. No wonder that physicians equate their profession with their identity. This sentiment, along with other factors, has resulted in many physicians continuing to practice well beyond the average retirement age. While each individual ages differently, there is evidence that the aging of physicians and length of time since medical school and residency is associated with deficiencies in history-taking, physical examination, record-keeping, and the ability to problem-solve. For late-career surgeons performing complex surgical procedures, there is a higher mortality rate for patients. Unlike other professions that have a mandatory retirement age, medicine does not. Health systems are grappling with how to fairly assess the competence of late-career practitioners. This article will explore that challenge from different perspectives, identify best practices, and describe how a risk manager can facilitate stakeholder discussion focused on implementing a competency-assessment process that is fair and effective.