Volume 6, Issue 9 S A M B A T A L K S - PAGE 2 February, 2007

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Need advice about a problem case in ambulatory anesthesia? Suggestions about a difficult situation in your ambulatory surgery center? A reply to questions others have raised about ambulatory anesthesia issues?

If you answered "yes" to any of these questions, or would like to share with other professionals a comment or opinion on a topic related to ambulatory anesthesia then please "Join the Discussion".

Your question, reply or comment will be published in the next available issue of SAMBA TALKS. Include your name (or initials), email address, city, and state, if you would like these published. Please note that because of the high volume of questions we receive, there is often a delay of 1 to 2 months before publication.

SAMBA Talks will include all discussion questions we receive considered of interest to the membership at large. We will endeavor to publish a response to at least one of these questions. The response will be from experts in the field, and from those willing to express a view on a particular topic, backed by experience and/or published evidence. Where email addresses are published, those individuals have indicated their interest in discussing the published questions.

Questions and responses from previous months are now available at the eNewsletter Discussion Archive. If you have any comments regarding the previous questions, please submit them to SAMBA Discussion, and they will be published here next month.

Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

?? - LAST MONTH'S QUESTION WITH REPLIES - ?? - TOP

Question

I am the medical director of a surgery center in New Jersey.  There is a transportation service used by the facility on a hardship basis to transport cataract patients.  These patients receive propofol for their procedures. The service is used 4-5 times per thousand cases. Clearly a taxi driver or bus driver is not a responsible adult for discharge purposes.  However, this is a patient transportation service that escorts the patients into their houses.  Is this considered a responsible adult?  I would appreciate any help with this dilemma.  Thanks.

-- Richard Zalman, MD ( Richard.Zalman@atlanticare.org)

Reply 1

This is a very hard question to answer. There is no true answer. Propofol is short acting and should be worn off if no fentanyl or midazolam is used. However, what is the responsibility of the transport service personnel. Are they trained?  Do they take the patient and help the patient into the house? Or do they just drop the patient off at the door (as they have other people in their van).

We do not have the evidence based medicine or medico-legal support to say it is OK to do so.

--Frances Chung, MD, Toronto, Canada

Reply 2

CMS Standard 416.42(c) states, "All patients are discharged in the company of a responsible adult, except those exempted by the attending physician."  Thus, if you regard a patient transportation driver as responsible and do not foresee any difficulty arising from the patient being alone at home, you may proceed in terms of compliance with a regulatory entity.   I still have my own personal/professional reservations regarding this approach and I insist on a patient's family member or friend assuming responsibility upon discharge.

--Thomas Cutter, MD, Chicago, IL

?? -- THIS MONTH'S QUESTIONS -- ?? - TOP

Question 1

I work with a high volume plastic surgery group doing some extensive procedures on outpatients.  What info is there regarding DVT prophylaxis/risk stratification for outpatients?   Thanks. 

-- Jill Hester MD, Williamsburg, VA (whester3@cox.net)

Question 2

The MHAUS guidelines say it's OK to anesthetize MHS persons as outpatients providing triggering agents are not used, and that they can be discharged after 1 hour in PACU plus 1.5 hours in secondary PACU.  However, my colleagues refuse to anesthetize MHS or any first-degree relatives of MHS persons at our freestanding, non-hospital affiliated surgery center.

What opinions do others have on this issue?

-- AG Pashayan, MD, Greensboro, NC (agpashayan@earthlink.net)

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