My experience with an unexpected ambulatory potentially preventable complication: The importance of 3M AM-PPCs

For the past two decades, I've had the privilege of being part of the 3M Health Information Systems team. As a principal methodology consultant for the population and payment solutions group, my primary role involves educating clients about our payment and quality software platforms and methodologies. Last year, I had the exciting opportunity to delve into a new methodology released by our clinical and economic research group – 3M™ Ambulatory Potentially Preventable Complications (AM-PPCs). This marked my chance to learn a methodology from its inception, and I eagerly joined the knowledge team dedicated to this project. 

Our team began creating slide presentations and reference materials to help clients understand this new grouper. We analyzed data, ran coding scenarios and explored the logic behind identifying complications. 

During this journey, Dr. Sandeep Wadhwa, our chief medical officer, delivered an eye-opening talk about ambulatory complications. He drew our attention to an analysis 3M performed on Medicare data, which revealed that certain categories of elective outpatient procedures had complication rates higher than expected. One statistic that caught my eye was the approximately 1 out of 20 patients receiving an esophagogastroduodenoscopy (EGD) procedure had an emergency room or inpatient admission with a potentially preventable complication. It was genuinely surprising to me, but little did I know that I would soon become part of that statistic. 

Not long after Dr. Wadhwa’s talk, I experienced abdominal pain and consulted a gastroenterologist who scheduled an EGD procedure. After undergoing the procedure and waking up from the Propofol IV sedation, I unexpectedly sneezed three times in a row. Although it struck me as unusual, I attributed it to a hand lotion I had received from one of the post-op nurses. None of the medical staff seemed alarmed except for offering a polite "bless you." 

On the drive home, my sinus issues escalated dramatically. My left nostril ran incessantly, I couldn't stop sneezing, and my eyes watered. Even after washing my hands, I couldn't find relief, and taking Benadryl proved futile. I endured this discomfort until bedtime, assured by my husband that I'd feel better the next day. 

However, when I awoke, my symptoms persisted. The nurse from the ambulatory surgery center (ASC) called to check on me, and I described what I was experiencing. She mentioned that a few patients had faced similar issues and recommended using over-the-counter nasal spray. As the day wore on, my misery only intensified, prompting my husband to search for answers online. That's when we discovered I wasn't alone in my suffering – I had post-procedural rhinitis following intravenous sedation with supplemental nasal oxygen, aptly abbreviated as PRAISE SNOG. Research papers on this condition are numerous, and it afflicts around three percent of patients. The use of Propofol, which slows breathing, requires patients to wear a nasal cannula and oxygen during the procedure, and this causes sinus and membrane mucosal irritation and, consequently, this complication. 

I never anticipated experiencing a respiratory complication from an upper gastrointestinal endoscopy. This experience shed light on the significance of 3M AM-PPCs. Historically, identifying post-procedural complications has been challenging, as the outpatient procedure and the complication's identification and management often occur separately. Thanks to the efforts of 3M’s clinical and economic research team, we now have a way to link coding and claim/billing information to identify these complications. 

With hindsight, I realize that the ASC could have done more to recognize and help manage my symptoms. Armed with this knowledge, I can inform future anesthesiologists of my need for an oxygen mask instead of a nasal cannula. While it may seem like a minor issue, I have no desire to relive those two miserable days, and my sinuses remain irritated even three weeks later. 

The key takeaway from this experience is the critical role of identification, awareness, prevention and education in addressing these complications. You can't prevent something you're unaware of, and superficial awareness, like suggesting nasal spray, is insufficient. My journey serves as a real life example of how 3M AM-PPCs can improve health care by providing better information on patient complications and the source of these complications. 

Lisa Lanier, BS, CCS, principal methodology consultant at 3M Health Information Systems.