It only takes one – How ASCs can limit serious adverse events & prioritizing patient safety

Surgery centers continually strive to provide patients optimal care, but sometimes complications arise following a procedure that staff personnel cannot prevent. However, some complications are within a surgery center's control and may completely change a patient's life if centers don't work to prevent them.

"One of the most feared complications in interventional pain management is paralysis or quadriplegia," says Scott Glaser, MD, DABIPP, co-founder and president of Pain Specialists of Greater Chicago. "These are not common cases, but when they occur, they are nightmares. A person's life is ruined and it has huge repercussions for the facility and the doctor."

A rare complication of epidural injections is epidural hematoma. When these occur, it is hours or more following the procedure. This is a risk no matter where the procedure is performed. To limit the chance of this adverse event and to reduce the adverse sequelae, surgery centers and any other location these are performed can implement and follow strict protocols as well as pay close attention to a patient's medication throughout the episode of care.

Dr. Glaser notes patients may also suffer paralysis if physicians do not safely perform transforaminal epidurals, with published literature detailing 22 cases in which patients became paralyzed following this procedure.
 
Dr. Glaser has done extensive research, publishing and lecturing about this complication to try to eliminate this risk in the future.

"The standard of care is changing secondary to our efforts but it is still halfway there," he says. "Pain management doctors and surgeons are still doing these procedures using the safe triangle technique which puts patients at risk."

To ensure centers are doing everything in their power to reduce this risk, administrators can insist their surgeons are performing these procedures in the safest manner. If new literature illustrates a safer way to perform these procedures, the center's pain management physicians and surgeons should adopt this technique. As Dr. Glaser explains, "there is no reason physicians shouldn't switch to the newer technique."

Dr. Glaser emphatically states,  "The safer technique places the needle in the foramen in an area where the critical blood flow to the spinal cord has never been found, the Kambin triangle."

While surgery center physicians have a lot on their plate, patient safety should not fall by the wayside. Centers may have a relatively low complication rate, but it only takes one serious complication to ruin an ASC's reputation and alter a patient's life.

"Surgery centers should be focusing on patient safety as much as adding the latest and greatest procedure," Dr. Glaser says. "We as a medical community have to do our best to prevent these catastrophic events because the second they happen, a patient's life is changed forever."

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