Anesthesiologists asked to respond to emergency call…

May 24, 2012

Often, Anesthesia Groups are asked to provide emergency call to the local hospital. The problem is well known, what about the situation where an Anesthesiologist is working on a complicated surgery that requires all of the attention of the Anesthesiologist, and, then, there is a trauma case that is brought in to the hospital; there is no one available.

A specialist in patient safety from The Doctors’ Company recently addressed this risk management questions:

She says, if the on-call anesthesiologist is involved in a surgical procedure and another “emergent” patient presented to the hospital and no other members of the group are available to help out, there is some liability risk to the group.

The risk to the anesthesiologist currently involved in a surgical case of leaving the patient is abandonment of the patient he/she has anesthetized. That is a very real liability risk. So what this situation involves is a common challenge:

First, that the group/community/hospital is not large enough to warrant a backup on-call physician to the anesthesiologist on call. Second, is that the medical staff bylaws require a 24/7 anesthesia service.

The risk is shared between the hospital and the anesthesia providers with the vast majority of the risk belonging to the hospital. If an off duty anesthesiologist is contacted and refused to provide anesthesia service potentially that anesthesiologist could be named in a lawsuit on a theory that since he/she were contacted a physician-patient relationship was established. It is a weak argument and isn’t likely to hold up in Court. If the hospital called an off duty anesthesiologist and no one answers, then no liability exists.

The Anesthesia Group can only ask so much of its members, they are, reasonably staffing the hospital with one Anesthesiologist, 24 hours per day.

The hospital needs to implement transfer agreements with other hospitals, recognizing the limitation of the hospital’s ability to provide appropriate care if another surgical patient comes in requiring emergency surgery. In that case, the hospital is unable to provide the service and is obligated to transfer the patient to an equal level of care (if the receiving hospital has the capability to provide a full operating team including anesthesia) or higher level of care facility. The fastest way to make that happen is to have written transfer agreements in place. The hospital may argue that the time to transport the patient isn’t in the patient’s best interest. I would argue that the time spent calling all off duty anesthesiologists is delaying necessary care of the patient.

The Doctors’ Company Patient Safety Experts can meet with the group and even the hospital to help them navigate around these important, vital safety issues.