Economic realities of health care reimbursement and growing consumer demand have shifted health care delivery: from in-hospital to outpatient settings, and recently to physicians’ offices. What’s the best way to improve patient safety in this “Wild West of Healthcare?” A recent editorial in the New England Journal of Medicine pointed out that, according to the Agency for Healthcare Research and Quality, only 10% of patient safety studies have been performed in outpatient settings. Over the past decade, several professional organizations such as the ASA and ASPS (American Society of Plastic Surgeons) have generated recommendations and guidelines to improve office safety. As a result of concerns for patient safety, a few dedicated physicians representing different specialties came together to form The Institute for Safety in Office-Based Surgery (ISOBS), a Boston-based, independent, 501(c)(3) non-profit organization. The ISOBS was recently interviewed by the Wall Street Journal and a few other national newspapers, discussing the current issues facing office practices.6,7 Less than 2 years after inception, the ISOBS recruited an excellent team of experts representing various medical, surgical, and dental specialties, in addition to board members from the business, law, and public policy sectors. The ISOBS hopes to serve as a knowledge resource for patients and health care providers, detect educational gaps of the medical personnel involved in patient care, and encourage outcomes research and adverse event reporting. The ISOBS will organize patient safety symposia at subspecialty meetings, to generate discussion regarding providers administering deep sedation and utilizing ASA outcome data collection systems. The ISOBS has caught the attention of the Institute for Healthcare Improvement, the Massachusetts Medical Society, the Massachusetts Coalition for Prevention of Medical Error, Massachusetts Board of Registration, as well as national malpractice and health care organizations. Learning how to write papers with the APA format is a very important proficiency, to both students and professionals.
In addition, anesthesiologists are leading in their attempts to collect ambulatory outcomes data through the Society for Ambulatory Anesthesia SCOR database and the Anesthesia Quality Institute to develop the National Anesthesia Clinical Outcomes Registry (NACOR). The Institute’s mission is “to promote patient safety in office-based surgery and to encourage collaboration, scholarship, and physician and patient education.” The ISOBS is an organization of individuals from diverse professional backgrounds.
The ISOBS plans to provide opportunities for safety training through a variety of tailored online educational modules: to enable office personnel to assess mastery of core safety competencies and to develop a “Certificate Program” for office practices that have successfully completed this educational process.
This is particularly timely given recently updated CMS guidelines that reflect future changes in cost and reimbursement of healthcare. Urman, MD, MBA, is an Assistant Professor of Anesthesia at Harvard Medical School, Director of Procedural Sedation Management at Brigham and Women’s Hospital, and Chief Executive Officer for the Institute for Safety in Office-Based Surgery, Boston, MA.
Shapiro, DO, is an Assistant Professor of Anesthesia at Harvard Medical School, President of the Massachusetts Society of Anesthesiologists, and President and Founder of the Institute for Safety in Office-Based Surgery, Boston, MA.


Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers.
Developed by the Institute for Safety in Office-Based Surgery with contributions by Alex Arriaga, MD, Richard Urman, MD, MBA, and Fred Shapiro, DO, 2010. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. This is because the APA format, created by the American Psychological Association, exhibits a certain writing structure that is well-organized, neutral, and widely available for anyone. It should not at all be biased to anyone or anything, therefore making it versatile and relevant. But this is most significant to those who are planning to establish businesses and organizations alike. In addition, a vast majority of offices lack accreditation by one of the major accrediting agencies (AAAHC, AAAASF, JCAHO).
The idea is to have an entity endorsed by, and affiliated with, a range of anesthesia and non-anesthesia professional organizations. In 2010, the Institute sponsored a CME course at Harvard Medical School, “Anesthesia in the Office-Based Setting: Safe, Simple, and Pain Free,” followed by an inaugural reception to honor pioneers in patient safety, Drs.
And lastly, the APA format is a writing format that has tons of resources – making it easy for everyone to follow its standards.
The APA format is the first step into creating formal papers, and learning the writing standard will lead you to higher grounds. Whether such procedures are performed with or without an anesthesia care team provider, current issues include patient and procedure selection, perioperative management, complications, and recovery. The number of offices involved in this study represents a small fraction of office-based surgery practice, because the majority of offices are unaccredited. With leadership drawn from several specialties, the ISOBS would seek to engage these groups with the common goal of building consensus for best practices and defining uniform regulation, rather than having individual, uncoordinated efforts, or externally imposed regulations. Physician assistants must complete a master’s degree that prepares them exam, diagnose and develop treatment plans.


Non-patient related issues include proceduralists performing outside their scope of practice, substandard facilities, and lack of qualified office personnel. A Society for Ambulatory Anesthesia newsletter highlighted the need for better office education of surgeons, proceduralists, nurses, legislators and the public.4 In addition, OBS practices face increased pressure by “medical necessity” policies instituted by commercial insurers.
In addition, the ISOBS wants to help patients learn about safe OBS practices and to obtain the tools needed to understand their health care provider’s and facility’s credentials.
As of 2001, the ASA Closed Claims analysis has only 37 office-based cases, due to a 3-5 year lag between occurrence and entry into the database. Physician Assistants Job Duties and Work Environment  More than half of physician assistants work in a physician’s office, with most of the rest working in hospitals. While job responsibilities can vary depending on the location and specifics of the job, a physician assistant will typically: Perform physical exams to check patient’s health, including ordering and interpreting diagnostic tests such as X-rays or blood tests Make preliminary diagnoses on a patient’s illness or injury. This handbook includes advice on planning your career path and outlines steps you can take to increase your chance of professional success. Typically, those interested in becoming a physician assistant will complete a bachelor’s degree program in a related field, such as nursing, then enter the 2-year master’s degree program. Often, candidates in the master’s degree program will have worked in other healthcare fields such as emergency medical technician or as a paramedic.
Get Matched with Top Healthcare Degrees and Physician Assistants Programs  The Accreditation Review Commission on Education for the Physician Assistant has accredited 165 physician education programs which are offered at allied health schools, medical schools, academic health centers and colleges and universities. Coursework usually involves pathology, anatomy, physiology, clinical medicine, diagnosis and medical ethics. Most also include supervised training in family medicine, internal medicine, emergency medicine and pediatrics. A license must be obtained by passing the Physician Assistant National Certifying Examination administered by the National Commission on Certification of Physician Assistants.



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