With all due respect, I found your cover headline "Feeling the Heat?" somewhat inappropriate. To be blunt, I found your attempt at journalistic wit to be tacky at best. Had there not been loss of life with the Houston ASC arson, your clever calembour might be more understandable, but as there have been many innocent people hurt by this tragedy, something more compassionate to the victims would have been a better representation of how (at least) your readership feels. Leave such clever(?) captions for The New York Times and and elevate Outpatient Surgery to a higher standard.

John Baeke, MD
Park Place Plastic Surgery
Overland Park, Kans.
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• I didn't realize an accreditation could be that stressful. I can't imagine a rational person going to this extreme.
• I knew accreditation was stressful, but I had no idea it could be this dangerous.
• Geez, I thought I'd heard it all!
• I can't believe she went to that extreme. Why didn't she just tell her boss she wasn't ready?
• What experience did this LPN have that qualified her to be responsible for a AAAHC survey?
• Makes you wonder why she was the person responsible for this task.
• Accreditation is a team effort, and he should have had an RN and practice administrator working on this together. Did the surgeon have no input? How about accountability for his practice direction?
• Had she confided in anyone, this could have been prevented.
• Nursing is making people crazy!
• Wow! This takes the stress of accreditation to a whole new level!

Not All OR Nurses Are Gowned
Re: "Can the OR Team Cause SSIs?" (Manager's Guide to Infection Control, May Supplement, page 4). Not all OR nurses "cover their bodies with sterile cover gowns." In fact, the minority do. The article doesn't hold much weight if this is the premise that the author was working on to prove that home-laundering scrubs won't increase infection rates.

Joan Tuber, RN, BSN
Director of Surgical Services
Shriners Hospital for Children
Springfield, Mass.
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Keep Ephedrine on Hand in the PACU
Re: "The Recipe for Preventing PONV" (April, page 33). I'd like to add that, in the PACU, relatively low blood pressure is often the trigger for nausea, sometimes masked by pain or retching. A small dose of ephedrine IV (5mg to 7.5mg) followed by a bolus of IV fluids will often control the nausea without adding any additional medications that may cause drowsiness and increased recovery time. If the ephedrine doesn't work, you can always give the other meds.

Jack Egnatinsky, MD
Anesthesiologist, AAAHC surveyor, Immediate Past President, FASA
Christiansted, U.S. Virgin Islands
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What's He Doing at the Head of the Table?
Re: "Finding the Right Anesthesia Provider" (May, page 37). David Bernard's 10 attributes of the "right" anesthesia provider might be fine and dandy, but nothing beats a professional who knows what he's doing. The "anesthesia provider" pictured in the article has failed to turn on the oxygen and is reaching for isoflurane - the volatile anesthetic that is least appropriate in outpatient surgery.

Martin S. Bogetz, MD
Professor of Clinical Anesthesia
Medical Director, UCSF Surgery Center
University of California, San Francisco
San Francisco, Calif.
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Timely Dictation Speeds Payment
Re: "13 Billing Strategies to Get Paid Faster" (March, page 42). I've used these same strategies for years and they work. You must get the docs on board to dictate timely - it is, after all, their money, too.

Catherine Goldhammer
Goldhammer Consulting
Reno, Nev
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