Survey of Oral and Maxillofacial Surgeons’ Offices: DISCUSSION

In: Anesthesia

22 Sep 2009

Survey of Oral and Maxillofacial Surgeons' Offices DISCUSSION

A simple 1-sentence, 7-question, yes or no survey does have some benefits, including increased chances of response, decreased likelihood of confusion, and minimal time consumption on the part of the respondent. The high rate of return was much higher than most surveys and far above the required minimum usually needed for statistical analysis. Two questions were constructed to discern whether or not nurses were employed and perceived as important professionals who have either surgical or anesthetic care experience. Six of the 42 offices that had nurses apparently used them as surgical assistants or office managers, but not as part of the anesthesia care team. Although many surgeons might like to have a nurse in the office, there are probably several reasons why this “desire” might not be carried to fruition, including salary costs; the type of anesthesia or surgery practice, which might not warrant the employment of a nurse; and the limited availability of qualified nurses in the work force. There were no provisions in the questionnaire for identifying the nurse.

This is an indicated therapeutic standard. Given the medico-legal climate today, it appears that a significant number of offices could be at risk for successful litigation should this issue (lack of current ACLS) be identified by a malpractice claimant or plaintiff attorney as either a direct or indirect cause of the severity of an adverse outcome of the anesthesia care given in the office. For example, a question might arise concerning whether adequate ACLS maneuvers were applied while awaiting an emergency medical team (EMT) or ambulance transport if the surgeon was not currently trained in ACLS.
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All offices that perform sedation or general anesthesia according to the Office Anesthesia Evaluation Manual require the presence of a defibrillator. This is also supported in the Parameters, which states that a “facility equipped with emergency drugs and equipment that allow complete ACLS intervention, including a device to confirm end-tidal C02, is required.” This means that in addition to a C02 detector, a defibrillator is required equipment. It appears that 3 of the 128 (3%) offices were not in compliance with the need for a defibrillator. It would be hard to misinterpret this question given that defibrillators come as 2 types, the now well-publicized automated external defibrillators, which are in many public places, and manual types, which require specific application guidelines based on ACLS knowledge. Viagra Super Active

There are drawbacks to this survey, including the lack of cross-check follow-up questions to prevent the presentation of erroneous answers and the lack of in-depth questions in different words to gather more specific data. For example, in question 5, “up to date” may have been interpreted as meaning that the surgeons did not get the new improved data in the ACLS 2003 publication that was recently released. It is also possible that the surgeon’s ACLS certification just recently expired and the surgeon was in the process of enrolling in a future course. Additionally, there are ACLS and BLS courses available that are not “officially sanctioned” American Heart Association courses, but rather are refresher courses that do not certify participants.

Another example of the lack of in-depth data is question 6. The survey asked whether the office had the AAOMS manual. It is possible that an earlier (1995) edition, rather than the most recent (2000) edition, was in the office. The implication is that since up-to-date inspection criteria in the manual were not available, the surgeon might be less prepared for an inspection. aciphex medication

Despite some inadequacies, the survey did appear to ask some important questions and elicit answers that have not been addressed before in Virginia. Similar surveys of other states that do have strong office inspection programs in place would be valuable.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.