Motivation of staff to create a “safety culture”  Credentialing and privileging for office procedures  Developing/updating/enforcing office policies  Conducting regular mock safety drills  Tracking and reporting adverse events  Establishing a nonpunitive quality improvement process
The Business Case for Quality and Safety be the primary issue regarding anesthesia safety. When nonanesthesia certified providers are managing the patient, appropriate credentialing and privileging should be documented.
The task force strongly recommends the use of checklists, drills, and time-outs to verify the appropriate progress of office-based procedures. Checklists improve safety and effectiveness in other industries as well as health care (41–43). Verifying that the correct procedure is being performed on the correct patient during a time-out for confirmation is useful in the office setting, and drills and simulations are essential activities in high-reliability organizations. Advances in technology are expected to move many more invasive procedures into the office setting, and patients and providers will expect that these are performed with high-reliability and safety.
Through the Presidential Task Force Report, ACOG provided a blueprint for improving patient safety in the office setting (61). In parallel with this effort, ACOG convened another ad hoc committee to design a Web-based tool for outpatient practices to perform a self-assessment and gauge the degree to which they have implemented important safety measures. The work of this committee resulted in the Office Patient Safety Assessment (OPSA) tool. ACOG members can utilize this tool online to evaluate the safety environment in their office practices in four major domains. The first is Office Safety Culture, which includes questions about patient identification, team training, and communication. The second is Practice Management, which looks at utilization of electronic health records or other systems to track patient appointments and inquiries, and reporting normal and abnormal diagnostic tests. Third is Medication Safety, which asks about practices related to accuracy of medication lists, medication prescribing, and the dispensing of drug samples. The last domain is Procedures, which evaluates the appropriateness of patient selection for office procedures, equipment availability and maintenance, and safe anesthesia practices. The various elements in these domains provide a roadmap for improvement in those office practices where physicians find they have not yet instituted some of these recommended features (61).
Given the evidence that supports efforts to improve the quality and safety of medical care, why is there still much work to do in this crucial area? One explanation is that the misaligned financial incentives inherent in the reimbursement systems for physicians and hospitals are not designed to offer a “business case” for quality in providing medical care (63). This means that there is no monetary reward for improving quality in medicine, and pursuing that goal will result in higher costs. However, Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), and others, maintain that it is possible to improve care and dramatically lower costs (64).