The following quality improvement activities for office-based anesthesia are recommended by the American Society of Anesthesiologists' Committee on Ambulatory Surgical Care and the Society for Ambulatory Anesthesia's Committee on Office Based Anesthesia.
1. Conduct a site visit before initiating anesthesia services to determine what is needed to meet ASA guidelines.
2. Be particularly vigilant in evaluating unaccredited practices. Be aware that peer review outside of an accredited entity is not protected from legal discovery.
3. Have a written plan in place to continually assess, document and improve anesthesia care outcomes. The plan may include peer review, benchmarking and risk management.
4. The quality improvement plan should specify who is responsible for performing each element of the plan.
5. The plan should consider elements such as deaths, drug errors, cardiac or respiratory arrest, unplanned re-intubation, aspiration pneumonia, anaphylaxis or adverse drug reactions, unplanned hospital admission and wrong procedure or patient. It should also examine central nervous system or peripheral nervous system deficit within two days of anesthesia, myocardial infarction within two days of anesthesia and pulmonary edema within one day of anesthesia.
6. Participate in ongoing continuous quality improvement and risk management activities at each practice.
7. Keep in mind that most of the safeguards would not be there unless specifically addressed by the anesthesiologist.
8. Consider establishing internal and external benchmarks, and compare the practice's complication rates to the national averages.
9. Keep in mind that ultimate responsibility for quality improvement rests with each facility or the organization responsible for providing patient care.
10. A group providing anesthesia care at multiple facilities may form its own quality improvement unit to evaluate the total anesthesia care it provides.
11. Quality indicators should include patient satisfaction.
12. The quality improvement plan should include at least one annual check of anesthesia and emergency equipment to ensure compliance with current safety standards.
13. Conduct regular reviews of facility quality improvement at each office facility where anesthesia is provided regularly. Reviewers should include the medical director, a representative of the anesthesiologists currently providing patient care and a representative of the operating room or recovery nursing staff. The reviews should be conducted at least once a year and reviewer should keep written minutes that include their conclusions.
14. Solo practitioners in office-based practice should consider external review by peers.
15. Sedation by non-anesthesia providers should be included in the quality assurance process.