A s a certified registered nurse anesthetist (CRNA), I provide anesthesia services for plastic and endoscopy procedures in an office-based setting. Office-based practice has unique advantages and efficiencies that are similar to an outpatient surgery center while requiring the same vigilance and standard of care as any other perioperative practice setting. Advantages of officebased practice, when compared to an inpatient or other outpatient setting, include increased patient and provider convenience and satisfaction, scheduling flexibility, staffing consistency, efficiency, patient privacy, increased cost-effectiveness, and decreased risk of infection. 1,2 My experience as a member of small clinical teams, providing patient care for both brief and sometimes lengthy procedures, confirms the importance of teamwork, effective communication, and collaboration during all phases of patient care.Office-based team members have multiple responsibilities that they complete collaboratively. These responsibilities include optimizing patient care, improving communication with the patient, and building and promoting a culture of safety. Additional responsibilities that affect the provision of care in the office-based setting include participating in professional advocacy, participating in professional associations and leadership activities, and contributing to the sustained financial success of the office-based setting.
THE OFFICE-BASED TEAMIn an office-based environment, the perioperative team is a small cohesive group of clinicians with the common goal of providing safe patient-centered care. To meet this common goal, the team members implement patient selection criteria, work to improve communication with patients, and promote a culture of safety.
Optimizing Patient SafetyHaving established criteria for patient selection and identification of risk factors related to office-based procedures provides the team with guidelines to optimize each patient's safety and outcomes. Factors used to determine the appropriate care for patients include nurses and other care providers assessing the patient's health, anesthesia and psychosocial history, complexity of comorbidities, type and duration of procedure, and postoperative care requirements. 3 To provide appropriate support for the patient's care, he or she may be asked to complete a health history questionnaire before admission. Having this information allows the anesthesia professional time to discuss with the team how to optimize the patient's care before the The AORN Journal is seeking contributors for the Patient Safety First column. Interested authors can contact Sharon A. McNamara, column coordinator, by sending topic ideas to journalcolumns@aorn.org.