Improving Medical Office Communication and Safety

David O. Hester, FASHRM, CPHRM, Director, Department of Patient Safety and Risk Management

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

Communication with Hospitals, Labs, and Other Healthcare Providers

Physicians and staff members interact with other health professionals and facilities regarding many aspects of patient care. It is vital to develop effective procedures for handling calls and test results received from outside departments—including nursing, laboratory, pathology, and radiology—and from any other consulting services.

Include the following instructions in your procedures for staff members who handle calls and reports:

• Document the details when receiving diagnostic results or information about a patient referral over the telephone, and read it back to verify accuracy. Verify the spelling of the caller’s name, and obtain the necessary information for a call back.
• 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 an urgent finding, a panic value, or a routine test result.
• Note in the patient’s record the date, time, and degree of urgency of every call.
• When calling another physician’s office to make an appointment, state the patient’s name and phone number, reason for the call, degree of urgency, and 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. Request notification if the patient does not keep the appointment; document that information in the patient record, and inform the physician. Consideration should be given to obtaining an informed refusal attestation in follow-up.
• Be particularly alert to laboratory, radiology, and pathology reports and to consultation letters from other physicians. Reports and letters should be reviewed, 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, properly relayed to the patient, and follow-up is documented.

Communication in the Medical Office

Improve office communication and documentation 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 job descriptions.
• Document missed and canceled appointments in a patient’s chart, and always bring patient nonadherence to the physician’s attention. Establish a missed appointment protocol that outlines the appropriate follow-up action and is consistent with state and federal privacy laws. Document all efforts to contact the patient, including copies of letters sent.
• Identify and update the patient’s allergy information during each encounter, and document it in a prominent and readily accessible location. Ensure that all physicians and staff know where to document and review allergy information.
• Correct billing and collection errors promptly. If a dispute occurs, stop all billing action until the issue is resolved. 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 required standards and applicable payer contracts.

Emergency Response

Prepare for emergency situations by following these tips:

• Have a written protocol for managing medical emergencies that defines the role of staff member responders. Perform regular practice drills.
• Ensure that all staff who deal directly with patients are trained in cardiopulmonary resuscitation.
• Make sure all relevant staff know the location and proper use of oxygen, resuscitative equipment, and drugs for emergent conditions.
• Inspect emergency drugs periodically for expiration dates, and check emergency equipment and supplies to ensure readiness to respond.
• Log all drug and equipment inspections and the corrective actions taken. The log entry needs to be dated and include the initials of the staff member conducting the activity.
• Have written protocols for handling bomb threats, armed intruders, and individuals exhibiting threatening behaviors. Ensure staff training, perform regular practice drills, and document in human resource files.
• Have written protocols for handling natural disasters. Ensure staff training, perform regular practice drills, and document in human resource files.

Equipment Safety

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

• 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.
• 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, and mark it clearly that the equipment is out of service.

Summary

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