Rhinoplasties and Patient Safety

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Start with a Checklist
In Atul Gawande’s New York Times Best Selling book, The Checklist Manifesto, the physician describes the importance of checklists. From building skyscrapers to running hospitals, checklists ensure projects and procedures are safe and effective. In my industry, there are multiple ways to measure the patient-safety record of a plastic surgeon. For example, the Institute for Safety in Office-Based Surgery has an ISOBS patient’s checklist. In the checklist, ISOBS stands for Inquire, Stable, Office, Best, Suited, Plan, and Communication. Each word has a question associated with it:

Inquire: What are my doctor’s credentials?
Stable: Are my medical conditions stable?
Office: Is the office accredited and licensed?
Best: Is the office the best place for my procedure?
Suited: Can this office handle an emergency?
Plan: After the procedure, what is the plan for my recovery?
Communication: After the procedure, who should I call if I have questions?

I recommend using the ISBOS patient’s checklist. As much as the medical industry is highly regulated, there remains room for procedural variation, and the ISOBS checklist is a consistent method of comparing doctors. I’ll provide two examples to illustrate my point.

Part of “Inquire” involves asking the “yes” or “no” question, “Does the doctor have privileges to perform the same procedure at the hospital?”

This question addresses the surgeon’s expertise, credentialing, and reputation. Hospitals have the medical industry’s highest standards. Thus the length of time a surgeon has had hospital privileges points to his or her long term performance in the operating room. Years of hospital privileges indicate a surgeon has upheld high safety standards and maintained a long track record of safely completing procedures.

When you’re searching for the best doctor to perform your nasal reconstruction, you want to make sure he or she has considerable experience performing this procedure. In particular, this checklist item separates newcomers from experts who have completed countless procedures and know how to address multiple what-if scenarios.

Next, “Office” asks the question “Is the office accredited and licensed?” “Accredited” refers to AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities) often referred to as the “gold standard” for quality patient care. I currently serve as president of AAAASF. 

Some, plastic surgery practices, such as mine, have in-house, accredited surgery centers where doctors can perform rhinoplasties. If your surgeon has an in-house surgical facility, make sure it has earned the AAAASF seal of approval, or accreditation from one of the other accrediting associations . If not, my simple suggestion is to move on to another doctor.

Due to the delicate nature of rhinoplasties, you should only trust skilled surgeons who have accrued a long list of satisfied patients and track record of performing procedures safely. While the subject matter of plastic surgery safety will most likely never make the cover of a popular magazine, assessing a doctor’s safety record is one of the most important steps to experiencing a satisfying surgery that will provide the long term benefits you’re looking for. By using the ISOBS patient’s checklist as a guide, you’re off to a solid start.

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Los Angeles Plastic Surgeon