Shared Responsibility for Preventing Malpractice Suits—Special Circumstances

Each member of a medical care team plays an important role in reducing the number of incidents that cause patient dissatisfaction, injury, and lawsuits.

Avoiding Communication Errors with Hospitals, Labs, and Physicians

Not all patient care communication occurs with patients. Physicians and staff members interact with other health professionals and facilities regarding various aspects of patient care.

Develop effective procedures to handle calls from hospital nurses, hospital departments (especially laboratory, pathology, and radiology), and any other consulting laboratories and services. Include the following instructions in your procedures for staff members handling these calls:

  • Obtain adequate information to allow the physician to make an appropriate evaluation of the call’s priority. For example, ask if the laboratory is reporting a panic value (an urgent finding) or if the call is to communicate a routine test result.
  • Obtain the necessary information for a call back. Record the date and time of every call and verify the spelling of the caller’s name.
  • When another physician’s office calls regarding a patient, note in the patient’s record the date and time, caller’s name, reason for the call, and degree of urgency. If in doubt about the referral, direct the call to the physician for response.
  • When calling another physician’s office to make an appointment, state the patient’s name and phone number, reason for the call, and degree of urgency. Also state whether the patient is being sent for consultation or referral. Record in the patient’s chart the date, time, and name of the person who received the call. Instruct the other physician’s office to notify you if the patient does not keep the appointment. If that occurs, inform the patient’s physician and enter the information in the patient record.
  • When receiving laboratory, pathology, or radiology reports over the telephone, write the information down, then read it back and ask the caller to verify the information.

Communications Within the Office

Improve office communications between you and your staff and among staff members by following these tips:

  • Establish communication procedures that promote efficient transmission of information and prevent messages from being overlooked or misinterpreted.
  • Schedule regular office staff meetings to improve communications, resolve problems, and develop a better understanding of each other’s needs.

Avoiding Common Errors with Special Procedures

The following suggestions can help you and your staff avoid common errors with special procedures:

  • Be particularly alert to laboratory, radiology, and pathology reports and to consultation letters from other physicians. Reports and letters should be seen, dated, and initialed by the ordering physician and should not be filed without the physician’s initials.
  • Develop and use a tracking system for all tests, procedures, and consultations ordered to ensure that results are received in a timely manner.
  • Document missed and canceled appointments in a patient’s chart, and always bring patient nonadherence to the physician’s attention. Establish a missed appointment follow-up protocol that outlines the appropriate follow-up action and is consistent with state and federal privacy laws. Document all efforts to contact the patient and the results. Notations and copies of letters sent to the patient should become part of the medical record.
  • Identify a patient’s allergies, and update allergy information during each patient encounter. Document allergies in a prominent location to ensure that the information is readily accessible. Ensure that all physicians and staff know where in the chart allergies are documented.
  • Correct billing or collection errors promptly. If a dispute occurs, stop all billing action until the issue is resolved. If a patient indicates dissatisfaction with a treatment or surgical procedure, the physician may want to consider forgiving the outstanding balance. The treating physician needs to review an account prior to pursuing collection action. Be sensitive to specific patient circumstances and work with patients to resolve unpaid balances prior to pursuing collection action.
  • Establish collection protocols that are consistent with evolving state and federal laws. The protocols should be consistent with community standards and applicable payer contracts.

Additional Error Potential

These tips can help you and your staff provide a safe environment for patients:

  • Have a written protocol for managing medical emergencies that defines the role of staff member responders.
  • Make sure all relevant staff know the location and proper use of oxygen and other resuscitative equipment and of drugs for emergent conditions.
  • Inspect emergency drugs periodically for expiration dates and check emergency equipment and supplies to ensure readiness to respond. Ensure that corrective action is taken as needed.
  • Log all inspections and the corrective actions taken. The log entry needs to be dated and include the initials of the staff member conducting the activity.
  • Ensure that all staff who deal directly with patients are trained in cardiopulmonary resuscitation.
  • Ensure that all electrical equipment is properly grounded.
  • Report equipment malfunctions to the appropriate person in your organization or office. Stop using defective equipment until it is repaired.
  • Maintain a schedule for preventive maintenance of equipment. Log the activity with a reminder of when the next scheduled maintenance should take place.
  • Ensure new staff members with clinical responsibilities are trained in the correct use of equipment. Document all training in human resource files.

Summary

All physicians and staff are responsible for improving office or organizational procedures and communications. By following the guidelines in this article, you can create a safer patient care environment.

 

By David O. Hester, FASHRM, CPHRM, Patient Safety Risk Manager.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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