We can be somewhat complacent when caring for ambulatory surgery patients since these patients tend to be healthy. (Image source: Thinkstock)
We can be somewhat complacent when caring for ambulatory surgery patients since these patients tend to be healthy. (Image source: Thinkstock)

Patients who undergo ambulatory surgery procedures tend to be healthier and undergo less invasive procedures as evidenced the fact that length of hospital stay for ambulatory surgical patients is usually less than 24 hours.  It stands to reason, then, that emergency pages in ambulatory surgery facilities should be few in number.

Dr. Toby N. Weingarten, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, and colleagues examined the frequency, indications, and major outcomes of perioperative emergency pages among patients undergoing more than 120,000 procedures in three distinct ambulatory surgery centers (ASCs) with 31 surgical and procedural suites (with 12, 11, and 8 surgical and procedural suites respectively) between June 1, 2008, and December 31, 2012, at the authors’institution.  The results of their analysis are discussed in the article “Emergency Pages Using a Computer-Based Anesthesiology Paging System in Ambulatory Surgical Centers: A Retrospective Review,” which was published in this month’s issue of Anesthesia & Analgesia.

At the authors’ institution, a proprietary computer-based anesthesiology paging system (CAPS) is used in the event of an emergency.  Any care provider can activate an emergency page via CAPS and the system displays the location of the emergency event throughout the facility. Over a period of about 4 and one half years, the CAPS system recorded 93 emergency pages, or 7.7 emergency pages/10,000 cases. Of these, 51 were recorded in the procedure room, and the remaining 42 were recorded either before or after the procedure (16 before and 26 after the procedure).  No patient died around the time of the ambulatory surgery procedure.  One patient developed an acute myocardial infarction related to a previously stented coronary artery that thrombosed. That patient never recovered and died 4 months later.

The most common reason for an emergency page related to cardiovascular causes was bradycardia. Bradyarrhythmias accounted for most of the pages outside of the procedure room (60.4%).  Interestingly, 8 patients had vasovagal signs or symptoms and experienced their event outside the procedure room where heart rate was not electronically monitored.  Respiratory and airway events were the second leading cause of emergency pages. Not surprisingly, most occurred in the procedure room.  94.6% of emergency pages occurred before 15:00 PM when the ASCs were usually staffed with two supervising anesthesiologists.

This is an interesting observational paper. We may be somewhat complacent since these patients tend to be healthier, but there can also be added pressure for anesthesiologists working in these areas to direct their attention to/care for more complex patients. Regardless, events happen.

The study authors’ proprietary paging system is only used by their institution and may not be applicable to other facilities. In their accompanying editorial, “Paging Doctor, Emergency?,” Drs. Brian S. Rothman and Jesse M. Ehrenfeld, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee, state that “it is clear that situational awareness is required throughout the entire perioperative period because emergency events occur with a sufficient frequency during preoperative and postoperative care.  Communication with anesthesia providers during these periods of care to facilitate a rapid response, evaluation, and treatment could mitigate or avoid significant evolving events and possibly improve outcomes.”  As Drs. Rothman and Ehrenfeld write, this article “points out a growing need for enhanced engagement and situational awareness by anesthesia providers outside the OR for patients still within the perioperative realm. As our practices change, it is crucial for whatever communication tools we use in the future to minimize workflow interruptions and false alerts.”