Dr. Melissa Langhan (Emergency Medicine, Yale School of Medicine) discusses case studies to improve patient safety through capnography.
“When medical tragedies occur, one of the very first questions asked by patients, families, the legal system, the press, and the public is: ‘were appropriate care standards met?’,” said Michael Wong, JD (Executive Director of the Physician-Patient Alliance for Health & Safety).
“Medical guidelines for monitoring during general anesthesia recognize the importance of monitoring with capnography,” observes Dr. Melissa Langhan (Assistant Professor of Pediatrics, Emergency Medicine, at Yale School of Medicine). “Unfortunately, continuous capnography is not routinely used outside of the operating room. Capnography can really enhance patient safety, and healthcare professionals need to think about using it more often.”
The medical standards of care upheld by healthcare facilities may differ. Although hospitals typically seek accreditation from The Joint Commission, ambulatory centers can receive accreditation from a variety of organizations.
For example, the American Association for Accreditation of Ambulatory Surgery Facilities (AAASF) accredits ambulatory surgery facilities like the one where Joan Rivers underwent her medical procedure. The AAASF standards are different than those of the American Society of Anesthesiologists (ASA), as discussed below:
What is instructive in terms of gained knowledge in the Joan Rivers’ death are the differing patient safety measures in place by the application of standards when a sedative is delivered to the patient.
The AAAASF standard would have monitored for oxygenation by pulse oximeter, which measures the amount of oxygen in blood. Measuring oxygenation provides a very late indicator of hypoventilation, or ineffective breathing. In other words, there would have been a delay in the detection of low blood oxygenation by pulse oximeter.
The ASA standards provide an extra level of patient safety by requiring that the adequacy of ventilation be monitored in addition to oxygenation. The ASA standards therefore call for the “continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide”.
Even in hospitals, however, multiple standards of care may exist. Although anesthesiologists, the recognized experts in providing safe sedation, are required to monitor adequacy of breathing by measuring exhaled carbon dioxide, non-anesthesiologists such as gastroenterologists, surgeons, and radiologists are not required to provide this extra measure of safety. For example, American Society for Gastrointestinal Endoscopy “Guidelines for safety in the gastrointestinal endoscopy unit” does not require monitoring for adequacy of ventilation by Capnography, as required by the ASA.
So, how can the safety of patients be better protected?
In this video interview, Dr. Langhan discusses patient cases where capnography improved safety and health outcomes – https://www.youtube.com/watch?v=V8sOkzXLZ0c
Dr. Langhan is on the Board of Advisors for the Physician-Patient Alliance for Health & Safety (PPAHS).