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Adherence to process and protocols is important in ensuring patient safety for iliac vein stenting in an office-based lab setting

      In their paper “Iliac vein stenting is safe when performed in an office based lab (OBL) setting,”
      • Satwah I.
      • Sulakvelidze L.
      • Tran M.
      • Lakhanpal S.
      • Kennedy R.
      • Lakhanpal G.
      • et al.
      Iliac vein stenting is safe when performed in an office based laboratory setting.
      the authors demonstrate the safety of central venous stenting performed in their OBL. The volume of outpatient endovascular procedures being performed in an OBL has been increasing since 2008, when the Centers for Medicare and Medicaid Services (CMS) increased reimbursement for these interventions.
      Medicare program; prospective payment system for long-term care hospitals RY 2008: annual payment rate updates, and policy changes; and hospital direct and indirect graduate medical education policy changes. Final rule.
      From 2006 to 2011 the annual rate of peripheral vascular interventions in Medicare patients increased only slightly (401.4-419.6 per 100,000), but the percentage of these procedures being performed in the OBL setting increased dramatically from 6 to 37.8 per 100,000.
      • Jones W.S.
      • Mi X.
      • Qualls L.G.
      • Vemulapalli S.
      • Peterson E.D.
      • Patel M.R.
      • et al.
      Trends in settings for peripheral vascular intervention and the effect of changes in the outpatient prospective payment system.
      This trend continued, and from 2011 to 2014, there was a 298% increase in OBL cases.
      • Mukherjee D.
      • Hashemi H.
      • Contos B.
      The disproportionate growth of office-based atherectomy.
      The reasons for this increase are many including patient satisfaction and convenience, physician preference, health care system cost savings, and physician reimbursement advantage. In addition, it is a more efficient use of the vascular surgeon's time, which is important given the vascular surgery workforce shortage projected to occur over the next 20 years.
      • Go M.R.
      • Oslock W.M.
      • Way D.P.
      • Baselice H.E.
      • Tamer R.M.
      • Kent K.C.
      • et al.
      An updated physician workforce model predicts a shortage of vascular surgeons for the next 20 years.
      Despite this increasing volume, data around procedural safety in this setting are still needed. The authors' success in maintaining a low major complication rate supports the use of this intervention in an office-based setting, which is valuable. However, perhaps even more valuable are the details provided concerning the patient selection, pre- and post-procedural care protocols, and the procedure protocol followed, which ensured that the authors perform these procedures safely. Just as importantly, the authors outline their quality assurance and performance improvement (QAPI) process and recommend that all OBLs become certified by the Joint Commission on Accreditation of Healthcare Organizations and establish a robust QAPI process. The QAPI process is critical to patient safety, as well as to ensuring appropriate patient and procedure selection. OBLs have been associated with some controversy with regard to overuse of high reimbursement procedures.
      • Mukherjee D.
      • Hashemi H.
      • Contos B.
      The disproportionate growth of office-based atherectomy.
      Having a robust QAPI process can help ensure appropriate use, and if performed properly will lead to the delivery of safe, effective, and cost-efficient care in the office-based setting, which has the potential to improve both patient and physician satisfaction. It is this focus on processes and standards that I find most compelling in this paper, and it serves as an example of how to perform office-based procedures safely and effectively.
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      References

        • Satwah I.
        • Sulakvelidze L.
        • Tran M.
        • Lakhanpal S.
        • Kennedy R.
        • Lakhanpal G.
        • et al.
        Iliac vein stenting is safe when performed in an office based laboratory setting.
        J Vasc Surg Venous Lymphat Disord. 2022; 10: 60-67
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        Fed Regist. 2007; 72: 26869-27029
        • Jones W.S.
        • Mi X.
        • Qualls L.G.
        • Vemulapalli S.
        • Peterson E.D.
        • Patel M.R.
        • et al.
        Trends in settings for peripheral vascular intervention and the effect of changes in the outpatient prospective payment system.
        J Am Coll Cardiol. 2015; 65: 920-927
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        • Hashemi H.
        • Contos B.
        The disproportionate growth of office-based atherectomy.
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        • Go M.R.
        • Oslock W.M.
        • Way D.P.
        • Baselice H.E.
        • Tamer R.M.
        • Kent K.C.
        • et al.
        An updated physician workforce model predicts a shortage of vascular surgeons for the next 20 years.
        Ann Vasc Surg. 2020; 66: 282-288

      Linked Article

      • Iliac vein stenting is safe when performed in an office based laboratory setting
        Journal of Vascular Surgery: Venous and Lymphatic DisordersVol. 10Issue 1
        • Preview
          Venous stenting for iliac vein outflow obstruction is associated with excellent long-term stent patency and symptom resolution. However, the safety of iliac vein stenting performed in an office-based laboratory (OBL) setting is not well-defined. The purpose of our investigation was to determine the safety profile of iliac vein stenting in an OBL setting.
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