As physicians perform more procedures in their offices, the concern as to their ability to respond to emergencies that could arise, also increases. This affects a broad range of specialties, including not only the surgical specialties but radiology, pediatrics, allergy and other practices. Essentially, if procedures that increase the potential risk that a patient may need emergency medical response are performed in a practice, then that practice should develop a plan for response.

In developing such plan, the following should be considered:

Personnel
Does the practice have staff that is adequately trained to assist the physician in responding to such an emergency?

For example, in a given practice it may be important that staff is trained in CPR. Where this training is considered necessary, staff should be recertified as appropriate and documentation (copies of the certificates) maintained.

If staff other than the physician is performing a procedure, is that person able to determine that an emergency is developing and take the necessary action expeditiously?

The physician should be available to his/her staff if they are performing procedures independently. If it is considered acceptable that the physician is not present in the room, then (s)he must be immediately accessible, if necessary.

Equipment/Medication
Does the practice maintain equipment and medications appropriate for initial response, to the kinds of emergencies that could reasonably be expected to arise?

For example, if a practice administers allergy injections, the physician(s) must ensure that their emergency supplies are adequate to treat anaphylaxis.

Is this medication stored in an easily accessible, self contained unit that can be readily moved to the areas where it may be needed?

If a practice performs a special procedure which is more likely to result in an emergency (e.g. stress tests), then the emergency equipment should be kept in the area where that procedure is performed.

Is all staff aware of this equipment and its location?

It is important that existing and new staff know where to find the equipment and supplies.

Is this material checked regularly to ensure that medications have not expired and that equipment is in working order?

It is a good idea to maintain a checklist as a reminder to complete these checks and also as documentation of the checks.
This would provide evidence of your efforts to be prepared to address these potential emergencies.

Roles & Responsibilities
Is the staff aware of what they would be required to do in such an emergency?

Unless these responsibilities are defined, panic may lead to ineffective actions which may result in delay in obtaining needed care for the patient.

Are these responsibilities reviewed periodically with the staff, as a reminder of the potential for emergen­cies?

In large/busy practices, it may even be helpful to have periodic practice sessions ("mock codes").

Emergency Transfers
If necessary is the practice able to arrange for emergency transportation of a patient to a nearby hospital?

If the nearest hospital is not one at which the physician maintains privileges, it may be prudent to develop a transfer agreement with that facility.

Documentation
Is everyone in the practice aware of the importance of documentation regarding such an emergency?

During the emergency itself, everyone is usually busy attending to the patient's needs, however, as soon as possible, a complete and objective note regarding the incident should be written in the patient's medical record.

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship