Patient safety is more important than efficiency

Editor—In his letter Isaac, a staff anaesthesiologist in the United States, suggests the establishment of outpatient surgical facilities.¹ I am well aware that “office surgery” has been heavily promulgated recently in the United States on the grounds of “efficiency,” financial or otherwise.

In the United Kingdom general anaesthesia as an outpatient in the dental surgery was a constant feature for many years. Most of the original bickering concerned the low fees paid to the administrator of the anaesthetic. After 1959 concern focused more on safety. Committees were formed, commissions appointed, and working parties convened. All made recommendations, but sporadic, usually avoidable, deaths in dental surgeries continued to occur.

I participated in several discussions, and it was plain that the solution of banning general anaesthesia in dental surgeries was unacceptable because of the effect on the income of the dentist (who often used to administer the anaesthetic) and the “anaesthetist,” where this was an attending doctor, often a general practitioner. It was not until 1999, after yet more deaths, that the British government took the decision to ban general anaesthesia in dental surgeries. It seems ironic that it took the United Kingdom 40 years to accept that general anaesthesia is safest when given in a fully equipped and fully staffed facility when there seems to be an increasing interest in office based surgery and anaesthesia on the other side of the Atlantic.

Boulton has given a fascinating account of the story of anaesthesia in the dental surgery.² It would be sad to see the problems resurface in the name of efficiency. Patient safety is more important than efficiency.