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Jessica Poole: Patients need to ask questions | TribLIVE.com
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Jessica Poole: Patients need to ask questions

Jessica Poole
| Wednesday, January 23, 2019 7:00 p.m
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America’s health care delivery system is undergoing a dramatic shift. More and more patients are choosing office settings and ambulatory surgical centers (ASCs) over hospital-based outpatient units for same-day surgical procedures for everything from total joint replacements to cataract surgery.

This shift is attributed to advancements in surgical techniques, pain management and anesthesia, and it’s changing the health care landscape that’s been familiar to patients for so long.

Outpatient facilities provide patients with easier access to care, lower costs, efficiency and a more comfortable environment. Outpatient surgery also allows patients to safely and comfortably recover from surgery in their own homes, avoiding unnecessary and costly hospital stays, which many patients prefer.

There are at least 244 ambulatory surgical centers in Pennsylvania, according to data provided by the Centers for Medicare & Medicaid Services (CMS) in June 2018. Roughly half of all surgeries performed in the country are now done on an outpatient basis.

Plastic surgeons, podiatrists, dentists, ophthalmologists and other specialists provide surgical and other services in outpatient settings that used to be available only in hospitals. These procedures and surgeries include cataract surgery, dental restoration, endoscopy, orthopedic surgeries, podiatric surgeries and pain management procedures.

Outpatient office settings and ASCs usually specialize in the procedures they perform. That focused care can enhance the patient experience and help maximize surgical outcomes.

As a certified registered nurse anesthetist (CRNA) who works in these settings, I have seen patients with more complex and acute medical conditions visiting offices and ASCs for outpatient procedures. Be assured that anesthesia is practiced to the same safety standards in outpatient settings as it is in hospitals, by both nurse anesthetists and physician anesthesiologists.

As health care professionals, we make sure individuals and their families are fully informed from the start so they can make the best decisions about their care. At the same time, with more complex procedures being performed more frequently in office settings and ASCs, patients have a responsibility to be more vigilant, too.

Not everyone is a candidate for outpatient surgery. Patients need to ask questions to better determine whether an outpatient facility is the right fit. That means asking about the facility’s licensure and accreditation and making sure equipment is up to date and well-maintained and the environment is sterile;

Patients also should determine whether a nurse anesthetist or board-certified anesthesiologist will be involved in sedation or anesthesia, and whether there is an adequate number of well-trained staff to support the surgery and anesthesia. This is critical since any anesthesia option should be based on the patient’s physical condition, current medications, type of surgery and other patient-specific factors. Only an anesthesia professional can make that determination.

Patients should ask about a center’s ability to treat problems or emergencies and plans for transfers to other health care facilities or hospitals, if necessary.

A health care professional’s responsibility to the patient doesn’t end when the patient leaves. Patients should find out what the process is for discharge, recovery and follow-up care.

Ensuring the best possible health outcomes from any medical procedure means asking all the right questions and getting all the answers you need before you ever set foot in a surgical waiting room.


Jessica Poole, DNAP, MHS, CRNA, works with a private practice serving Southwestern Pennsylvania. She lives in Unity.


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