Re: "HOPD or ASC: Which Model is Better" (December, page 6). I am intrigued that we remain in an either-or situation in our mental model for surgical-care delivery. I have long been an advocate of ASCs under the umbrella of a larger system or hospital, yet less than 11 percent of the nearly 3,000 ASCs in the United States were hospital-owned in 2003, according to Verispan.

Hospital-owned ASCs have access to all the resources listed in your editorial including contracting, with the advantage of being able to operate with the flexibility and efficiency of an ASC. While I strongly support the separation of in- and outpatient care, providing the two services in distinct environments is key to ensuring efficiency and offering wellness care. We should be working together, a somewhat unpopular but nevertheless obvious stance.

I am in the process of developing a center that will be a partnership between the surgeons and a hospital. Along with that project, we are helping the main operating room learn some of the lessons we have learned in ASCs so the two will be seamless to staff, physicians and patients. I write because I have been asked to document the process so that the system can use the information to develop multiple centers within its very large system. The fact that I came out of retirement to do this project is witness to how important I believe it is to bridge the gap to create a healthcare system that provides excellent care with all the scope and promise technology has to offer that is seamless to patients.

Outpatient care is very different from inpatient care; both are needed. Together we can do what neither of us can do separately. I would hope to see outpatient campuses continue to grow in popularity with the hub being the hospital.

Nancy Kessler, BSN, MS
CEO, Glendale Adventist Surgery Center
Glendale, Calif.
writeOutLink("[email protected]",1)

No Opioids, No Oxygen, No Fires
Re: "Preventing Surgical Fires" (December 2003). Your otherwise excellent story failed to mention the advantages of using BIS-monitored propofol ketamine (PK) anesthesia as a pre-emptive solution. Essential to PK technique, which provides the illusion of general anesthesia to the patient, is the avoidance of opioids, which eliminates the requirement of oxygen, an ignition source for fires.

Barry L. Friedberg, MD
Corona del Mar, Calif.
"[email protected]")

ECRI's Mark Bruley replies: I have no criticism of the technique he described in that it will not promote oxygen-enriched ignition or flame spread under the surgical drapes. My comment was addressed to the all-too-frequent use of 100-percent oxygen delivered to the face via open-mask or nasal cannulae during conscious sedation without questioning its need for a particular patient and/or without titrating the percentage of delivered oxygen based on pulse oximetry or other intraoperative indicators.