The intersection of patient safety and office-based procedures

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Dr. David Mayer is an expert in the field of patient safety and one of the most vocal advocates for increased awareness around common and unforeseen safety issues in healthcare. Currently, he is the executive director of the MedStar Institute for Quality & Safety (MIQS). In this role, Dr. Mayer leads specific quality and safety programs in support of discovery, learning, and the application of innovative methods to operational clinical challenges.

Recently, The Scope had the chance to sit down with him to discuss some of the misconceptions surrounding patient safety and what he wishes providers and patients knew. Particularly, we dig in on the fallacy that safety eats away at the bottom line and precipitates increased costs, as well as the overall safety of hospitals versus ambulatory settings for procedures.

How should we think of patient safety in the big picture of healthcare?

I believe the only way that we could ensure the highest-quality, safest care possible is to prioritize patient safety. It should be our number one mission, regardless of whether you’re in hospital, you’re in an ambulatory surgery center, you’re in an endoscopy clinic, or you’re in your primary physician’s office. Safety should always be prioritized.

And how does overall safety factor in for patients?

When you talk to patients, as I have for many years, they will tell you three things. First priority, don’t harm me. Second priority, heal me. Third priority, treat me well. We could do number two; we could heal them and we could treat them well. But, if we harm them along the way, they remember that and we shouldn’t have that ever happened. But preventable medical error has continued to occur, unfortunately, at pretty high rates. And so, we still have ways to go to ensure the highest quality safest care.

Do we sacrifice safety when we move procedures out of hospitals and into offices and clinics?

With newer technologies and innovation, we continue to see procedures and surgeries moved out of the hospital. That could be a good thing, but that could also be a bad thing. And it’s how we approach and how we address the movement of those cases. Hospitals, truly in many ways, while they do great work, are not safe environments. That said, if we’re doing things quicker and cutting corners in an ambulatory environment because nobody is looking over our shoulders, then it could be an unsafe environment compared to a hospital.

I’ve really found, as I’ve looked at these ASCs and endoscopy centers and others, it’s the leadership. If they embrace safety as a priority and ensure that they’re going to follow the same infection prevention bundle, they’re going to do the same timeout with the checklist, they’re going to do the same recovery room approach and follow up, their numbers, infection rates, can be lower than hospitals because of those environments.

Certainly, hospitals are the right setting for many types of procedures, but is it too much for some other procedures?

Yes, doing ambulatory type procedures in the hospital… Let those procedures move to a facility like an ambulatory surgery center or an endoscopy center, as long as that center embraces the same safety approaches as those physicians and others embraced when they were in the hospital.

Because when you look at it, where would I rather go, assuming patient safety was equal on both sides for an elective non-urgent, non-critical type procedure? I’d rather go to endoscopy center or an ambulatory surgery center, as long as I knew that it was accredited the same way the hospital was accredited, that there are certain minimum standards and guidelines, that they have a crash cart and a defibrillator, and their people are trained in ACLS type techniques.

If safety is the same, why choose the ambulatory setting?

I’d rather go to an ASC or endoscopy center because it’s so much easier to navigate. You’re in, you’re out. And, you don’t have to be involved with people who are taking care of very critically ill patients in a huge building that, sometimes, is very difficult to navigate through. It’s the convenience of these ambulatory sites that makes them better for not only the physicians in doing those procedures, but it makes it better for the patients and family members who are involved with those procedures.

How should we think about safety as it relates to the bottom line?

I think one of the biggest missed concepts out there is, to invest in safety is to add cost into the process. There’s great examples that when hospitals have cut down their serious safety events, have improved their quality and safety and have less infections and less bed sores, they save money and they’re more profitable. So, I think that concept that patient safety is something that we got to invest in, it will not bring a return on our profits, is totally unfounded.

But do some still worry that to move a procedure out of the hospital and into an office or clinic makes it less expensive, but also less safe?

As we move things out of the hospital into these ambulatory facilities, as long as we’re addressing the safety issues, they are much more cost effective, they are much more convenient, and we’re able to create an environment that reduces the cost of healthcare.

For many years, when you went into the hospital for an elective type procedure, you were paying more money for a number of reasons than you would if you were in an ambulatory environment. Somebody has to cover the cost of some of the other things that hospitals have to do. The way that hospitals bill and charge, it just creates an environment where these elective cases, which they make a lot of money off of as they’re very profitable cases, as they move to the ambulatory environment, we’re seeing that cost-savings. And we’re seeing it in many places without the cutting of safety and quality measures, without trying to go quicker, faster, and maintaining the things we’ve learned that will keep the environment safe from harm.

For more, check out our podcast on patient safety with Dr. Mayer here.