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Five Ways to Prepare for an Outpatient Surgery Emergency


By Elizabeth Even, MSN, RN, CEN, Senior Associate Director, Clinical Standards Interpretation, The Joint Commission

In the chaotic world of the operating room, experienced staff know one of the keys to safe patient outcomes is preparing for the unexpected. With well over 100 million outpatient surgeries performed each year in the United States,1 it is a given that not everything will go exactly according to plan. While some variances may be minor, others may not be — and preparing for the unexpected could be the difference between a successful outcome or a sentinel event.

To keep unexpected events from harming patients, ambulatory surgery centers (ASCs) can implement precautions that enable them to respond quickly and effectively to emergencies during outpatient surgery.

1. Establish a culture of safety. First and foremost, the culture of an operating suite can make all the difference when it comes to patient and staff safety. Transparent and supportive leaders can help reduce and mitigate emergencies during outpatient surgery. These types of leaders respect staff who are comfortable enough to “stop the line” when safety concerns arise during a procedure. They also encourage the reporting of near misses and adverse events because staff know they won’t be punished.

2. Prior to surgery, conduct a comprehensive physical examination and medical history. Joint Commission standards require a comprehensive assessment of a surgical patient’s physical condition and their medical history. This assessment includes an evaluation of changes to their health or medical history that may affect the surgical procedure.

This preparation enables the care team to:

  • determine any possible variation in the surgical procedure
  • prepare supplies/equipment that may be required
  • identify and prioritize risks
  • anticipate mitigation strategies that may be required in case of an emergency

Identifying risks and ensuring the entire team is prepared for an emergency increases the likelihood of a smooth recovery after an adverse event. 

3. Test emergency equipment and have access to emergency supplies and medications. Depending on the procedure, emergency equipment may include suction, a defibrillator, airway equipment and various IV access equipment.2 Additionally, the outpatient surgery team should have access to a sufficient inventory of blood products and appropriate emergency medications.2 Whenever possible, use the same types and volumes of equipment, supplies and medication throughout the organization to facilitate ease of use and mitigate errors.

4. Regularly assess staff competencies. Emergency equipment, supplies and medications are only as good as the staff who use them. Competency requires knowledge, technical skills and ability. To assess competency, a healthcare organization validates, through a defined process, an individual’s ability to perform a task in a way consistent with how they were trained to perform it. Document all competencies in an individual’s personnel file. 

5. Perform drills or practice tabletop exercises in response to identified risks and “what if” scenarios. Depending upon your facility’s risk assessment, you may wish to practice responding to scenarios involving suction that no longer works or expired emergency medication in the crash cart. Running drills of this nature will help develop contingencies to use in real-life emergencies. It’s important to “test to failure” when conducting drills; this will help your organization to identify breaking points and develop ways to mitigate risks.

Preparing for emergencies during outpatient surgery can help instill agility and readiness in ASCs and their staff so that the next time an emergency arises they can work efficiently as a team to immediately address the situation and prevent patient harm. 
Elizabeth Even, MSN, RN, CEN, is a Senior Associate Director, Clinical Standards Interpretation, in the Division of Healthcare Improvement at The Joint Commission. In this role, she interprets the intent of Joint Commission standards, provides guidance to organizations and surveyors, and supports the accreditation process. Ms. Even has over 18 years of acute care hospital experiencing specializing in emergency medicine. With a focus on communication and safety, she is committed to professional development, safe environments of care and nursing leadership. 

1United States Outpatient Surgical Procedures Market 2019-2023: Rising Number of Outpatient Surgical Procedures in ASCs, HOPDs and Physicians’ Office, Research and Markets, Jan. 24, 2019.

2ACLS Training Center. Crash Cart Supply and Equipment Checklist. Nov. 18, 2021.