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Fall 2011

The Institute For Safety in Office-Based Surgery (ISOBS)

Fred E. Shapiro, D.O.
Assistant Professor of Anesthesia, Harvard Medical School, Boston - ISOBS Founder

In recent years, the economic pressures of medicine have incited a paradigm shift in health care delivery, such that surgical procedures are moving from the hospital to the office-based setting. Often called the “wild west of health care,” office- based procedures continue to increase at a rapid pace, with an estimated more than 10 million procedures performed in 2010. A growing body of literature calls for greater leadership in the field of office-based surgery, and for leaders who are educated in all facets of quality improvement. In addition, a recent study found that a comprehensive checklist used in an interdisciplinary, team-based setting resulted in a reduction in surgical complications as well as cost savings.

Development of such a checklist and education of practitioners, patients, and office personnel is the mission of the Institute for Safety in Office-Based Surgery. An independent, non-profit 501(c)(3) organization, ISOBS has developed a safety checklist for use in the office-based setting. The checklist, shown in Figure 1, calls on engagement from RNs, MAs, PAs and physicians to ensure safe care. Perhaps most important, the checklist is fully customizable to a variety of office-based settings, from elective plastic surgery to ophthalmology. ISOBS recently completed a retrospective chart review using the checklist, and is now proceeding to the prospective phase of checklist deployment. In addition, ISOBS is developing web-based educational modules for practitioners on using the checklist.

The need for leadership in office- based procedure performance is clear. Without tools to aid patient safety, neither practitioners nor patients will have the security they deserve. Using a comprehensive safety checklist as well as associated educational modules, ISOBS aims to fill this void and supply practitioners with innovative yet common sense tools to protect their patients.

For further information, see Shapiro FE, Durman RD. Office-Based Anesthesia and Surgery: Creating a Culture of Safety. ASA Newsl. 2011; 75(8);10-12. ISOBS also publishes a complimentary electronic newsletter to which you may subscribe through the organization’s website,

ISOBS will host a reception at the ASA Annual Meeting in Chicago on Friday, Oct. 14, 2011 honoring Atul Gawande, MD and Mark Warner, MD, for their contributions to the field of patient safety.

Fred E. Shapiro, DO, is Assistant Professor of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center Department of Anesthesia Critical Care and Pain Medicine, Boston, MA. He is Co-Founder of The Institute for Safety in Office-Based Surgery (ISOBS), Immediate Past President of the Massachusetts Society of Anesthesiologists and member of ASA Committees on Patient Safety and Education, Quality Management and Departmental Administration (QMDA), Governmental Affairs, and Ambulatory Surgical Services. He can be reached at