Signing Off and Signing Out: Lost in Translation

Whether signing out to a colleague for the weekend or permanently closing a practice, handing off responsibility for patient care can create liability risks for the physician. The safety of the handoff process has been called into question by a number of different sources and studies that suggest handoffs are often characterized by communication failures and environmental barriers.1

Handoffs 

The primary objective of a handoff is to provide accurate information about a patient’s care, treatment, services, current condition, and any recent or anticipated changes.2

When a handoff occurs, a physician should communicate the following information to the next physician: the patient’s previous treatment, current condition, medications ordered to date, and any recent or anticipated changes in his or her condition. Although face-to-face communication is the most effective method, telephone communication can also be efficient. The key elements are setting aside sufficient time to relay the salient information, for the receiver to understand the data, and time for questions and answers. Standardizing the handoff process and content will decrease the omission of critical information.3

Patient Notification

Primary responsibilities for most practice changes focus on good communication with patients. Patients should be told what the changes will be, when they will occur, and how these changes will affect their continued medical care. Keeping your patients informed will avoid claims of abandonment.

If the change in practice entails temporary coverage by another physician, be sure that the patient is provided with the covering physician’s name, phone number, and the duration of the substitute healthcare provision.

When the change is permanent, a more formal process is necessary. A notice about closing your practice should include at least these elements:

  • Importance of continuing medical care
  • Information about acquiring a copy of the medical record
  • Date of final closure
  • Method(s) for referrals (usually the local medical society)

Medical Record Management

Short-term medical care transfer might include a brief oral update to the covering doctor about what to expect with current and acute patients. Office records should be made available if necessary. Hospital-based patient records should have documentation of the change, usually on the physician order form.

It is wise to provide a method for documenting patient phone calls to the covering physician that can be easily and quickly added to the patient’s medical record. Any patient encounter should be documented as is customary. Unless the matter is emergent, release of medical record information should be delayed until the temporary coverage ends. Long-term changes require a process for the safety and security of the medical records while providing ready access.

Ensuring Continuity of Care

When arranging temporary coverage, seek a physician who shares your specialty. If the specialty is either surgical or obstetrical, a backup cover may be advisable in the event that your locum tenens is actively involved with another patient. It is also a good idea to seek a physician with privileges at the same hospital. 

When selling or closing a practice, similar guidelines are prudent. If the doctor buying the practice shares your specialty and privileges at the same hospital, it will help ensure your patients’ continuity of care.

Details Matter

If at all possible, introduce your acute or active patient population to the covering physician. A pre-established process for billing is anther important detail. Determine who will be responsible for billing patients, thus avoiding double billing.

Remember to notify other practice associates of your impending absence. Provide dates of departure and return to applicable office staff, referring practitioners, answering service, local hospital, clinics, nursing homes, etc.

On returning from a temporary change, ask the covering physician to update you. Review documentation in medical records to avoid failure to follow patient care issues. Listen to feedback from those who worked with the covering physician to learn about the success or failure of the temporary change. Remember that all of the above may be applied in reverse when you are the covering physician.

Notifying The Doctors Company

Anytime a practice closes permanently, it is necessary to notify The Doctors Company Underwriting Department. This will ensure that past and future claim coverage will be addressed. A packet of informative materials on closing your practice is available by calling The Doctors Company Department of Patient Safety.

Please direct patient safety and loss prevention questions to the regional risk manager in your area, or call us at (800) 421-2368, extension 1243, in The Doctors Company’s home office.

 

References

  1. Arora V, Johnson J. A model for building a standardized hand-off protocol. Jt Comm J Qual Patient Saf. 2006 Nov;32(11):646-55.
  2. The Joint Commission. E-dition. Provision of Care, Treatment and Services Standards. https://e-dition.jcrinc.com. Accessed July 22, 2011.
  3. Arora V, Johnson J. A model for building a standardized hand-off protocol. Jt Comm J Qual Patient Saf. 2006 Nov;32(11):646-55.

 

By Ann S. Lofsky, MD (deceased), Anesthesia Consultant and Governor Emeritus; updated by Susan Shepard, MSN, RN, Director, Patient Safety Education.  


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.

J8422 10/11

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