Always Avoid the Bad Jobs—Know the Risk-Management Strategies of the Practice
Norman A. Cohen MD
Although improvements in the safety of anesthesia over the last several decades is nothing short of remarkable, anesthesia remains a high-risk endeavor. From the relatively frequent occurrence of dental injury to the lowerfrequency but far more costly outcomes of permanent nerve injury, cardiac injury, lung damage, or death, practices should devote resources to risk reduction. Aggressive attention to risk management can lead to substantial reduction in medical liability insurance rates. Mandatory continuing education requirements, internal review of adverse outcomes, and requiring informed consent for all procedures are some of the characteristics you may look for in a risk-management program.
ADAPTABILITY TO CHANGE
The environment in which a practice operates is constantly changing. From recognizing and addressing new competitive threats to accommodating new payment initiatives such as “pay for performance,” anesthesia groups must be able to adapt to and profit from change. To determine how your potential group manages change, you can ask open-ended questions about challenges facing the group and planned responses. If the group’s leaders deny that any challenges exist or blame any and all problems on outside entities without offering any proposed solutions, dig deeper, as both are warning signs of possible problems. Although the group doesn’t have to have a plan for every problem, it should have a well-defined process that will prioritize threats and lead to the development of a response. The process should be fairly inclusive, with input from all members of the group affected.
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Do Not Underestimate the Difficulty of Reintubating a Patient Who Has Undergone Carotid Endarterectomy or Cervical Spine Surgery
Don’t Overflush Lines
Do Not Treat Lactic Acidosis with Bicarbonate
Beware the Antibiotic Bowel Prep
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