Risk Management Guidelines for Anesthesiologists

Due to the nature of their specialty, most anesthesiologists have been involved in a fatal or serious incident that occurs to a patient during a surgical procedure. According to the International Anesthesia Research Society, 84 percent of all anesthesiologists will be involved in such an adverse event, and anesthesiologists can expect an average of 4.4 such events during the course of their career.

For this reason, anesthesiologists should spend extra time and precaution when doing their risk management due diligence. Following are a few risk management tips that anesthesiologists should incorporate nto their practice:

Informed Consent
Informed consent is a critical component of an anesthesiologist’s risk management routine. Many of the medical liability claim settlements involving anesthesiologists center on the element of informed consent. For whatever reason, patients often testify that they cannot remember their anesthesiologist discussing the risks inherent in any procedure involving anesthesia. In many of these cases, the anesthesiologist did not have a third party present during the preoperative interview and he or she did not make adequate notes in the medical record.

When documenting the preoperative interview with a patient, anesthesiologists should make clear notes in the medical record, such as “I relayed to patient the risks of general anesthesia, which includes sore throat, injury to the teeth and death.”

When a surgeon operates on a wrong limb or even a wrong patient, oftentimes the anesthesiologist will be named in the medical malpractice lawsuit. Right or wrong, this is a reality. Take the extra minute to verify the patient’s identity and read the surgical consent form. Everyone in the operating room will benefit from your due diligence.

Keep Adequate Records
If something out of the norm happens during a surgery, take the time afterward to notate the narrative. Rather than writing, “the patient coded; was rescuscitated,” it is better to be detailed, such as “narrow complex bradyarrhythmia unresponsive to atropine.” Be detailed. Include dates and times. Do this while the event is still fresh in your mind. Adequate record keeping is essential risk management after an adverse outcome.

Never alter your records. There is no easier way to be found medically negligent than to alter your medical records after being served with a claim. It looks as if you are hiding something, and today’s lawyers are adroit at discovering altered medical records.

Consult Preoperative Lab Results
In the case of an emergency situation, anesthesiologists often don’t have the time to consult lab work. But for non-emergency operations, all preoperative labs that could potentially change your course of action should be available and read as part of your risk management routine. It is important to remember that all lab tests and results will be on the patient’s chart when it is reviewed in a malpractice case. If you haven’t reviewed all the information available to you, you will appear to have been negligent in the eyes of a jury.

Child Delivery
Informed consent can be tricky when during child birth. Many times, an anesthesiologist will meet the patient for the first time when she is in active labor. Preferably, you should meet the patient earlier and discuss the risks in more relaxed circumstances. If that is not possible, mention the risks to the patient and include her partner if present. Allow them to ask any questions they may have.

Post-Operative Spinal Headaches
Spinal headaches occur in up to 40 percent of those who undergo a spinal tap or spinal anesthesia. Both procedures require a puncture of the membrane surrounding the spinal cord; in the lower spine, this includes the lumbar and sacral nerve roots. Patients with such complaints often are angry about not receiving appropriate care when they complain about postprocedure headaches.

Discuss the possibility of a spinal headache with your patient prior to discharge. Give the patient a phone number to contact you or another anesthesiologist should additional treatment be required.