Patient Selection for Elective Procedures

Susan Shepard, MSN. RN, Director, Patient Safety Education.

As the first medical professional liability insurer to establish a patient safety department, The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.

Use a well-planned patient selection process.

A well-planned and carefully executed patient selection process is a valuable tool for loss control. Assessing prospective patients who request elective procedures will help identify those who are good surgical candidates and those who may not be able to achieve a satisfactory result. During the first visit, take time to document answers to the questions listed below. This may help avoid the stress and disruption of a lawsuit.

  • Is this a repeat surgery or repair of another doctor’s work?
  • Has the patient sued anyone else?
  • Is this a workers’ compensation case?
  • Does the patient’s spouse or significant other know about the procedure?
  • If yes, does he or she agree with the decision for surgery? If no, why?
  • Is the patient financially able to handle the costs associated with the procedure and any additional procedures?
  • Is there a history of compliance with post-op instructions?
  • During the past two weeks (or in the two weeks prior to surgery), has or will the patient experience period(s) of extended sedentary situations (e.g., long flights, bed rest, extended car rides, etc.)?

Be aware of warning signs.

It is beneficial to assess the patient’s body language and behavior. There are warning signs that may warrant additional assessment by the doctor or mid-level practitioner. Below are examples of warning signs:

  • Appears angry and hostile, has sharp voice tone, defensive body postures, negative facial expressions.
  • Is resentful of questions, makes defensive responses, short or one-word answers.
  • Is demanding, self-centered, lacks sensitivity to others.
  • Is overly complimentary of doctor and office staff.
  • Has unrealistic expectations.
  • Blames another doctor for previous treatment.
  • Appears to be engaged in “doctor shopping.”
  • Has difficulty paying attention, is unfocused, interrupts, changes subject.

Follow the guidelines for informed consent.

Remember, the patient selection process does not replace the informed consent process and should not defer any of those questions.

Ask for input from the office staff.

Many factors affect a surgical outcome. It is our opinion that office staff can contribute valuable information in the selection process. Listen when the staff voice “gut reactions” regarding a patient or family member. Allow the staff to contribute to discussions of denial of care.

Select the right patients.

We are aware that many claims occur with patients who are not appropriate candidates for a procedure. These tips can help decrease the frequency and severity of claims.

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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