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As the number of complex procedures performed in ambulatory surgery centers continues to increase, facilities should ensure periodic review of their strategies to ensure patient safety and minimize risks. Several measures ranging from proper patient selection to an effective informed consent process to a comprehensive credentialing program are key strategies to reducing risks to patients and managing patient expectations.

Elective, office-based surgery has captured the interest of consumers and, more recently, the attention of state health care regulatory agencies. In most states today, patients can undergo cosmetic surgery, liposuction, endoscopy, colonoscopy, microlaparoscopy, and various other procedures requiring sedation or anesthesia in physician offices even though no regulatory safeguards that would ordinarily benefit patients in accredited or licensed facilities exist. Media accounts of deaths and serious injuries associated with liposuction and anesthesia performed in physician offices resulted in legislative and regulatory initiates, such as those in California and New Jersey. Increased regulatory oversight, changes in patterns of reimbursement, and greater consumer awareness of safety and quality-of-care issues should aid in reducing the risks of office-based surgery.

Various joint commission and individual state standards affect emergency radiology practice and have legal implications. The ACEP has entered the burgeoning field of practice guidelines; fortunately, their practice guideline preparation system is arguably the most thorough in medicine at this time. This is of great importance to emergency physicians, because practice guidelines are not without their own potential legal, educational, and compliance problems. Trends toward cost-reduction through reduced radiograph utilization are a real phenomenon in all of medicine. It remains to be seen if costs can be reduced without increasing legal exposure. Excellent clinical guidelines are helpful to emergency physicians. The Massachusetts ACEP model, which appears to effectively blend closed claim data into practice guidelines, has built-in educational support and compliance incentives. This model may become a national standard in the future. Pediatric radiology risk management issues, such as the statute of limitations, have been discussed. Emergency physicians should be knowledgeable about the most commonly missed pediatric emergency radiologic diagnoses. Some aspects of common emergency radiology practice patterns are of relevance to a discussion of risk management in emergency radiology. Issues such as emergency physician radiograph interpretation responsibilities and follow-up systems emerge repeatedly in malpractice claims. The use of CQI strategies may prove helpful in improving practice patterns. Communication between emergency physician and radiologists is critical. Good communication requires the development of good rapport and should pay dividends in improved patient care.

New federal and state legislation will subject physicians to increasing scrutiny in the 1990s. This article highlights these new laws and explores physician concerns about them.