About Maria Todd

Maria Todd is a former firefighter and EMT and still maintains disaster preparedness and disaster recovery certifications through FEMA.

For all the years and all of the medical practices that I have ever visited, I have encountered only one practice that had a manual for employees that outlined the doctor’s instructions for emergency procedures. No, I am not referring to fire evacuation plans, HIPAA disaster recovery and business continuity plans, (although I keep asking, I encounter very few of them committed to writing either.)

What I am referring to are the procedures that might be encountered in any medical practice at any time, but of particular vulnerability in the event that the doctor is away from the office, either in surgery or doing rounds, or simply on a day off.

Step One - Emergency Directory

Make up an emergency call list that includes names, addresses and telephone numbers of covering physicians, ambulance, hospitals and other where you can send emergency cases. Include non-emergency telephone numbers for routine response by fire, police, power, telephone drug treatment centers, the Red Cross and poison control centers. If you routinely use chemicals or utilize radiation and x-rays in the practice and face the potential of spills or radiation incidences, CHEMTREC, radiation emergency response teams should be listed as well. Ensure that you have access to your list in the event Outlook or another contact software application is unavailable. For the practice administrator, this should be programmed into your cell phone.

Step Two – First Aid Supplies

An emergency supply of first aid materials should be available in an unlocked cabinet apart from your regular supplies. I often peek into these when I do find them in a medical practice and they are often empty or have old leftover antibiotic ointment and unusable sizes of bandages and little else. Inventory these as part of your regular supply inventory routine, and replace missing supplies and outdated items immediately.

Step Three – Medical Emergencies

Have the doctor take a moment and dictate an emergency procedure for the following situations in the event a patient or staff member experiences the following and presents in the practice at a time when a physician is absent:

IT’LL NEVER HAPPEN

While your practice might be an internal medicine or family practice (where many of these may be routine), the smaller staff of a practice focused on a specialty, such as orthopedics, also need to be prepared. I have been onsite as a consultant in an orthopedic practice when the physician was absent and a hysterical mother walked in with her child who had just fallen at the bus stop. The mother was waiting for a bus outside and this free-standing medical building was the closest potential for help nearby. The doctor was away. At first glance, the child about two years old, sustained an open head wound, was bleeding from the face, gums, and scalp and was not crying. Pupils were uneven.

The medical assistant was there but only had a limited amount of training. The manager was a CPA with no medical training. As a former EMT and firefighter, action fell to me. The other two women stood by as if in a stupor until I directed one of them to call 9-1-1 and directed the other to get me some gloves and 4x4s.

It’s not enough to say “we do bones” so we don’t need to have plans for the rest of these things. You never know what might walk in the door.

ALERT and RESPONSIVE

On another visit to a South Florida medical practice on a hot sunny day, a patient scheduled for a routine physical was waiting in the lobby, and came to the desk to check on how long the wait would be. His color was pale, diaphoretic, and he was rubbing his left elbow. The receptionist had no medical training. The doctor was running late, so the first patients were already back and waiting. Not knowing what to be alert for, the receptionist had no way to know that she should ask questions when she encountered those three symptoms presenting simultaneously. The registered nurse employed there was in the back at her nurse’s station unaware of the situation up front.

Mr Routine Physical was in the process of having a myocardial infarction. Would your staff have identified the situation? Without a doctor present, would they have responded appropriately? Or would the patient have dropped in the lobby alarming all the other waiting patients?

FIRE DRILLS

In a medical practice, part of the site visit I conduct includes an examination of fire extinguishers. Often I’ve found that in a long established practice, the fire extinguishers are long past inspection, in need of recharge, and often located in places that the office staff has no idea where the heck somebody put them. Use the opportunity to hold a fire drill for the staff. Since the material inside has to be “spent” in order to recharge them, have the Training Officer or Fire Prevention Officer come to your practice and hold a two-stage drill. The same day you arrange the appointment with the training instructor, arrange for the recharge technician to arrive an hour after the trainer. Send half the staff as the first group to report to the parking lot. The drill includes actually pulling the pin and feeling what it feels like to actually discharge a fire extinguisher. Most people are intimidated by this as they’ve never done it before. They also don’t know to point the extinguisher directly at the flame base. Once they have taken their turn, they can return to the office. Next send the second group, and repeat the process. Last, turn the empty extinguishers over to the technician for recharge. Coordinate with other practices in the building. That way, everyone has training, and if one of you has a new hire between drills, you won’t have as long an interval to wait for the new hire to receive training.

Running a medical practice is hectic. I get it. Will that be your excuse if something happens that could have had a better outcome if only you’d done a little planning and training?

About the Author:

Maria K Todd, MHA, PhD is known around the world for her expertise and generosity in sharing ideas, techniques and practical tools with her colleagues in the industry. She is a leading health care industry consultant and described by clients and peers as a visionary and thought leader. Statistically, she is the leading trainer in managed care contracting worldwide.  Since 1989, she has lectured professionally through colleges, universities, seminar companies, publishers and non-profit professional associations as well as on-site private training classes for hospitals, medical groups, offshore revenue cycle business process organizations and pharmaceutical and medical device manufacturers. In total she has delivered more than 2600 managed care training classes and seminars to over 53,000 attendees and participants.  Every month the number grows higher and higher!

Conflict Disclosure: The author is a professional consultant and derives a substantial percentage of her income reviewing managed care agreements and advising hospitals, physicians and others on matters regarding managed care and contracted reimbursement. The author previously worked for a Health Plan in provider relations as a contract negotiator. The author has no other conflicts to declare. This disclosure accurate as of November 5, 2008.

Notice: Please remember that the opinions, and information contained in this document is that of the individual author.  These materials (1) do not constitute legal advice; (2) do not form the basis for the creation of any relationship; and (3) should not be relied upon without seeking specific legal advice with respect to the particular facts and current state of the law applicable to any situation requiring legal advice. These materials may only be reproduced with the prior written consent of Maria Todd.  These materials are provided with the understanding that the author is not rendering legal, accounting, or other professional advice or opinions on specific facts or matters, and, accordingly, such entities assume no liability whatsoever in connection with their use.

You can learn more about managed care contracting in Maria's latest book,The Managed Care Contracting Handbook, 2nd Edition (2009)

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