Strategies to Reduce Liability Risks for Hospitalists

Kathleen Stillwell, MPA, RN, Patient Safety/Risk Management Account Executive.

Hospitalists face liability risks as the inpatient’s attending physician, covering physician, consultant, and co-manager. Two common problem areas are confusion regarding the hospitalist’s role in the patient care continuum and miscommunication during the different phases of inpatient care, especially during handoffs. The following tips can help hospitalists reduce their liability risks.

Clarify the role and scope of care to be provided.

First, make sure that you, your group, and the hospital all agree on your job description and privileges. Explain your role to the patient and family. For example, are you covering for the attending physician or are you serving as the attending? Clarify your role with the other care providers to avoid confusion among the healthcare team regarding specific components of a patient’s care.

Be aware of when the greatest risks occur.

The most vulnerable times for communication breakdowns include the patient’s admission to and discharge from the hospital, transfer between hospital units or to a department such as diagnostic testing, transfer to a consultant, and when a clinician goes off duty or on vacation. Establish a system to ensure that follow-up care is completed with each handoff.

Use standardized communication tools and protocols.

Standardized communication tools, such as SBAR (Situation Background Assessment Recommendation), help to effectively manage communication between providers. At a minimum, communicate the patient’s diagnosis, current condition, recent changes in condition or treatment, and anticipated changes. Check with the hospital to find out which communication tools or protocols it uses.

Checklists can be helpful in obtaining basic yet vital patient information from either the patient or the primary care provider. Find out the patient’s code status, current medical status, preferences, medications, testing (completed, pending, and planned), and any new diagnosis that may be necessary for you to effectively manage his or her care.

Establish a follow-up system to ensure that further care is completed.

Use the following guidance to organize your communications during handoffs:

  1. What is important to communicate?
  2. Who needs to know what information?
  3. When should communication occur?
  4. How should the information be transmitted?
  5. Is there an opportunity for the receiver of the information to ask questions?
  6. How can I validate the communication was successful?

Our Interactive Guide for Hospitalists can help you reduce your liability exposure. Visit for tools to help you evaluate your key systems.

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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