The survey responses revealed that the reputation for specialty care was the most common reason that patients presented to their specialty ER. Patients were willing to pay an average of $340 per visit but, said Dr. Naunheim, “A certain number of patients were not able to answer this question.”
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August 2016He concluded that contingent valuation and willingness to pay can be used to determine the value of surgical services and that patients desire direct access to specialists.
Bottom line: Patients place an explicit value on specialty emergency services of $340 per visit on average. Ultimately, contingent valuation data using willingness to pay methodology may help inform statewide resource allocation and the availability of direct-to-specialist care.
Wrong Site Surgery
Yarah M. Haidar, MD, a resident at the University of California in Irvine, explained that while the Joint Commission has been tracking wrong site surgery (WSS) cases since 1995, it does not mandate that hospitals report all incidences of WSS. The California Department of Public Health (CDPH), however, does require WSS reporting, and Dr. Haidar presented her team’s retrospective analysis of original WSS reports to the CDPH from 2007 to 2014. The team’s analysis, which focused on 95 cases, found that the most common source of WSS was orthopedic surgery (35%), while the most common site was the knee (7%). The CDPH also documented three otolaryngology cases. The first was a Baha case that was noticed after incision. The second was a stapedotomy that was noticed after the middle ear was entered and the stapes were noted to be mobile. The third was a postauricular lipoma resection that was noticed by the patient.
Dr. Haidar offered several suggestions to avoid WSS, including calling for the patient or family to verify the surgical site during the perioperative encounter; however, in a discussion following the presentation, Dr. Duck said, “I really don’t know if we can completely stop this problem. We must continue to follow the established protocols and be acutely aware that wrong site surgery does occur.”
Bottom line: While otolaryngology has a low incidence of reported wrong site surgery, proper communication among team members in the perioperative setting and adequate medical record keeping should be reinforced to curb occurrences. Additionally, correct marking of the surgery site, identification of the wrong site separately, and adherence to universal surgical safety protocols may substantially reduce the rate of WSS.
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