Emerging concepts in anesthesia safety in the ambulatory setting: ENT and Ophthalmology
AE 510M.J
Subject & Catalog Number
Course Information
Description
In 1979, fewer than 10% of all surgeries were performed as outpatient procedures. Fifty years later, 70% of operative procedures have evolved beyond the walls of hospitals. It is estimated that there were 144 million outpatient procedures in 2023 with 15-20% occurring in office-based surgical settings. The exponential growth of anesthesia services for ambulatory patients has been driven by a combination of advances in technology, patient and provider preference, the need to lower costs, and more recently, from the COVID-19 pandemic. Most of the recent literature on office-based and other ambulatory care has focused on rapid growth and expansion, increasing complexity of procedures and patients, sedation by anesthesia and non-anesthesia personnel, and recent high-profile media attention surrounding unfortunate injury and patient deaths. Going forward, without uniform regulation of these practices in the USA, education of personnel to mitigate these events is crucial.
The purpose of this course is to expose students to adult and pediatric patients presenting for ambulatory surgical procedures and to understand the role of the anesthesiologist and the principles that guide the performance of safe anesthesia care in the pre-, intra-, and postoperative setting in a variety of ambulatory surgical and procedural environments: the hospital, ambulatory surgical center (ASC) and the office-based setting.
The role of the student begins as observational and will advance to guided participation based on the students' and the course Directors' comfort levels. A goal is to give students an appreciation for the multidisciplinary interaction between the anesthesia care team, surgeons, and nursing can be an integral part of patient safety. In addition, they will participate as a member of the anesthesia care team comprised of physicians and certified nurse anesthetists (CRNAs) helping gather information that will be integrated into the formulation of the anesthetic plan. The students will work with a cohort of 10 providers who have a special interest in education at all levels of training. Faculty tasks include choosing appropriate patients for each student, leading the discussion of safe anesthesia care, and assessing each student's engagement and learning. Evidence-based guidelines will provide the principles for safe anesthesia practice in the ambulatory setting.
The course has ten clinicians working with students at six sites, Mass Eye and Ear (MEE) main campus, MEE Longwood Ambulatory Care facility, MEE Office-Based Surgical Center in Lexington, and two affiliates of Brigham and Women's Hospital.
Methods of learning include close observation of clinical and practical care-provider decision-making, discourse with faculty members on safety measures, RCA2 methodologies, medical simulation scenarios, webinars, review of the Directors' efforts to improve patient decision-making regarding anesthesia and safety, case reviews, and assigned reading assignments. The time commitments of this rotation involve 5 clinical days per week with no call obligations. There will be an option for the student to shadow attendings working later in the day in the hospital, ASC, or office-based anesthesia setting.
The course directors will meet with each student weekly to review their activity and present feedback. Student will be encouraged to discuss any of their issues and concerns. At the end of the rotation, the student will be expected to prepare a 15-minute power point presentation of a medically challenging case (or RCA 2 analysis) either to a senior member of the faculty or as a case conference for the staff at grand rounds These are typically brief and are in the discussion style of communication between medical practitioners.
Class Notes
Please see this video for more information about the course.
Not Available for Cross Registration
Open to Domestic Visiting Students
