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Recent disasters across the country, whether natural or manmade, have proven the need for healthcare facilities to have detailed and flexible emergency management plans in place. In-patient hospitals are often viewed as the primary responders in an emergency, but this is changing, and Ambulatory Surgery Centers are being asked to take a more active role in community disaster response.

"We are beginning to see an evolution in the role ASCs play in responding to disasters that impact the community," said Jerry Gervais, CHSP, BSME, engineer and associate director of emergency management standards interpretation at The Joint Commission. "While our current standards for ASC emergency management require community involvement, surveyors are now more aggressive in drilling down to ensure ASCs have community-integrated emergency management plans."
 
He stresses these plans should already be in place as part of any accredited ASC's emergency management plan. However, Gervais says implementing active, community-integrated emergency plans may be a challenge for some ASC facilities because federal, state and local emergency planners are often more familiar engaging in emergency planning with in-patient hospitals. 

"It is important for ASCs to work closely with their counterparts involved with emergency planning in primary care hospitals in the community-together they can share resources and develop integrated emergency plans that serve the community," he advised.

Building a plan
When Patrice Spera, RN, MS, CRNFA, CNOR, was asked to develop an emergency management plan for Tampa Bay Specialty Surgery Center in Pinellas Park, Fla., she contacted their risk managers and a safety officer she had worked with previously to gather resources and best practices.

"I also contacted members from our Ambulatory SA. They were so helpful in guiding me through the emergency planning process and recommending other resources," Spera noted.  "AORN's Perioperative Emergency Resource Manual also provides valuable information to develop and implement an emergency management plan," she added.

Spera, who chairs AORN's Ambulatory Specialty Assembly, says the key to emergency planning in an ASC is to know the requirements of your accreditation agency and your state and local regulations.

In Spera's state, the Florida Agency for Health Care Administration (AHCA) provides a detailed checklist for emergency planning requirements, which Spera found very useful in developing her ASC's emergency plan. She also worked closely with her county emergency management division. "In Florida, county emergency planners must annually approve ASC emergency plans and AHCA reviews these plans, as well, so it's important to collaborate with county and state agencies to meet requirements as you develop your plan," she advised.

While emergency plans are usually tailored to expected emergencies, such as hurricanes in Florida, Spera stresses that ASCs need to expect the unexpected when developing and updating emergency plans.

"We are gearing up for hurricane season, but we also need to be ready for bomb threats, chemical spills, bioterrorism, floods, tornadoes and any other emergency that may impact our community," Spera stressed.

An all-hazards approach
Gervais of The Joint Commission agrees. He says the key to emergency planning in any healthcare facility is having a flexible incident command structure in place that can adequately respond to all hazards, whether natural or manmade.

"The day has come and gone when a facility could develop an adequate emergency plan within its four walls. All facilities, including ASCs, need to network with community responders, even competitors, to establish a two-way approach to patient care," he said. "Disaster is the great equalizer, and ASCs need to be ready to care for patients going to or coming from an in-patient facility."

Mock disaster drills are one way that staff at Spera's current facility, MPM Bardmoore Surgery Center, get a feel for how to communicate, respond and care for ASC patients during a disaster. Actually going through the motions of a drill can identify challenges that may arise. Drills encourage the staff to follow the facilities' emergency management plan with ease, Spera acknowledged.

"You need a tested communication and action plan in place for the entire team, including community responders and other facilities where you may transfer patients," Spera said.

She and other members of AORN's Ambulatory SA also emphasized the importance of quality measures for disaster planning to assess how an ASC responded in an emergency situation and find ways to improve processes.

"We need to ensure that we have the means to care for patients without compromising outcomes, especially with a high patient load we may need to care for in an emergency situation," said Kate Moses, RN, CNOR, CPHQ, Ambulatory SA chair-elect.

Recognizing the need to address emergency management in an ASC, members of AORN's Ambulatory SA are working to address needs and provide insight on the ways they have worked to develop detailed, flexible emergency management plans for their ambulatory facilities.

"Being able to share best practices across the country is the best way to help each of us take into consideration what we need to know to care for the community in any kind of emergency situation," Spera emphasized.

The Ambulatory SA is currently collecting emergency planning and response resources to post on the Ambulatory SA online community of practice. Spera and Moses encourage SA members to visit the Ambulatory SA's online community and contribute to the resources and discussions about ASC emergency preparedness.

Access the Ambulatory SA online community.

Additional Resources

Perioperative Emergency Management Resource Manual, Second Edition
AORN Bookstore

Emergency Management in Healthcare: An All Hazards Approach
The Joint Commission Resources  (order # EMPHC02)

Call 630-792-5900 to speak to an engineer specialist in emergency management at The Joint Commission.