Monday, April 21, 2014

Is Your Practice Prepared for a Medical Office Emergency?

handling emergencies in the medical practice
Medical practices, especially primary care practices, are generally ill prepared for the various kinds of emergencies that can occur right in the office.

There is considerable debate regarding what constitutes minimal preparedness for a doctor’s office. Some associations publish a list of the minimum requirements for a practice. Consult your individual specialty society for preparedness suggestions for your medical specialty. Each office should develop its own standards based on factors like staff skill levels, distance from the nearest emergency department, and availability of local emergency services.

The 10 most common emergencies encountered in a primary care setting are: 
  • Asthma exacerbation; 
  • Psychiatric episode; 
  • Seizure; 
  • Hypoglycemia; 
  • Anaphylaxis; 
  • Impaired consciousness; 
  • Shock; 
  • Poisoning; 
  • Overdose; and 
  • Cardiac arrest.
Comprehensive emergency preparedness takes a lot of work. You need written protocols and a comprehensive staff training program. Finally, appoint someone to be responsible for maintaining equipment, medications, and supplies and to ensure training for new employees and periodic refresher training for everyone.

Even if your physicians—and perhaps your nurses— have been trained in advanced cardiac life support, you may actually find your practice ill prepared for common emergencies that can occur at any time. In fact, many well-prepared practices made a commitment to readiness after a serious scare. Why wait until you suffer a close call—or worse— before getting serious about in-office emergencies? The ability to save a life ought to be a high priority in any medical practice.

You may not need a full-blown crash cart that includes costly equipment like a defibrillator or pulse oximeter in your office, but you do need some basic equipment and medications. Unfortunately, opinions regarding “minimal requirements” for an in-office stat kit vary considerably across the industry.

Time is the single most significant factor determining your minimal needs. The farther you practice from a hospital emergency department, the better-equipped emergency kit you’ll need. If it takes more than 10 minutes for EMS to arrive, you’ll likely need items for starting an IV, intubating a patient, and more.

Choosing consumable supplies and medications depends on time as well. Most kits include acetaminophen suppositories, bronchodilator, epinephrine (1:1000), and nitroglycerine tablets along with other basics like dextrose and saline. If it takes longer than 10 minutes for EMS to arrive, you may want to include items like parenteral antibiotics, corticosteroids, and Lorazepam or Haloperidol.

We certainly can’t give you comprehensive guidelines for building your crash cart—that’s why you should form a committee to review your particular needs and outline how your emergency-response program will work. Your committee should at least accomplish the following:
  • Evaluate equipment, supplies, and medication needs for your situation. 
  • Write detailed protocols for the major types of emergencies you may encounter. 
  • Determine staff training needs and arrange for classroom instruction and emergency drills. 
  • Appoint a physician, nurse, and manager to administrate the program, including maintain- ing supplies, ensuring training for new staff, providing for periodic review training, maintaining records, and modifying the protocols as necessary.
Every day you delay starting your emergency plans brings you one day closer to a possible in- house tragedy. It’s a shame that today’s practices concentrate efforts on dealing with billing, compliance, and profitable operations to the neglect of a fundamental element of medical practice: the ability to save lives. Preparing for a medical emergency is like creating a fire-escape plan: Better to have one and never need it than to need one and not have it.