How to Prepare For and Treat Potential Complications in the Outpatient Endovascular Center

Working in an outpatient endovascular center, also known as an office-based lab (OBL), prompts certain considerations that do not exist in a hospital setting. The most important consideration is that there is no immediate availability of an operating room, anesthesiology team, blood bank, code team, or any other subspecialists that may be needed in an emergency such as a procedural complication or patient decompensation. It is therefore incumbent upon those of us operating in an outpatient center to take additional precautions to both try to avoid complications and to promptly treat complications when they do occur. Failure to rapidly resolve complications may mean an unsatisfactory patient outcome or even death. If the problem cannot be managed on site, then an inter-institutional transfer may become necessary. A transfer requires that the patient is stable enough for transport and that a relationship exists between the outpatient center and a hospital and/or accepting physician(s) with the necessary skills to treat the problem. If the physician working in the OBL also maintains privileges at the receiving hospital, the transfer process may be smoother. In other cases, the local hospital may not have the expertise to resolve the problem and may only be able to stabilize the patient, with subsequent transfer to a more remote institution for definitive treatment. This latter situation describes my OBL, and I have consequently worked to put procedures and practices into place to try to prevent or mitigate patient complications.