Strategies to Reduce Liability Risks for Hospitalists

Kathleen Stillwell, MPA/HSA, RN, Senior Patient Safety Risk Manager

Hospitalists face liability risks based on their role as an inpatient’s attending physician, covering physician, consultant, and/or 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 liability risks.

Clarify Roles and Scope of Care

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

Be Aware of Risky Transitions

Hospitalized patients are most vulnerable to communication breakdowns during the following transitions:

  • Admission to and discharge from the hospital.
  • Transfer between hospital units or to a department, such as diagnostic testing.
  • Transfer to a consultant.
  • Handoff to another clinician when a clinician goes off duty or on vacation.

Use Standardized Communication Tools and Protocols

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

Use only approved translators. Document the name of the translator according to facility policy. Family is the last resort for translation.

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 System for Effective Handoffs

Use the following questions to organize handoff communications:

  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?

Learn More

The Doctors Company provides a wide selection of online tools—including an Interactive Guide for Hospitalists—on the Interactive Guides/Site Surveys page.

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 considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J11723 09/18


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