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Shared Responsibility for Preventing Malpractice Suits—Special Circumstances

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

Many components of patient care—in addition to direct patient contact—can lead to a malpractice lawsuit. Each member of a medical care team plays an important role in reducing the opportunity for patient injury and a lawsuit.

Communication Errors with Hospitals, Labs, and Physicians
Not all patient care communication occurs with patients. Physicians and staff members interact with other providers and facilities regarding various aspects of patient care.

Develop procedures for your staff to handle calls from hospital nurses, hospital departments (especially laboratory, pathology, and radiology), and any other consulting laboratories and services. Here are recommended instructions to include in your procedures:

• 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 a panic value (an urgent finding) or if the call is in response to a request from your doctor regarding a routine test.
• Obtain the necessary information for a call back. Record the date and time of every call and verify the spelling of the caller’s name.
• When another physician’s office calls regarding a patient, note the following information in the patient’s record: the date and time, the caller’s name, the reason for the call, and its degree of urgency. If medical staff is in doubt about the referral, make sure the call is directed to the physician for response.
• When calling another doctor’s office to make an appointment for a patient, state the patient’s name and phone number, the reason for the call, and the degree of urgency. Also state whether the patient is being sent for consultation or referral. Record the following information in the patient’s chart: the time, date, and person who received the call. Inform the other physician’s office that you wish to be notified if the patient does not keep the appointment. If that occurs, inform the patient’s doctor and enter the information in the patient record.
• When receiving laboratory, pathology, or radiology reports over the telephone, write the information down and then read it back and ask the caller if the information is correct.

Communications Within the Office
Improve office communications between you and your staff and among staff members 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 needs. A caring, knowledgeable, and courteous staff can help prevent needless dissatisfaction and resentment in patients.

Common Errors with Special Procedures
The following suggestions can help you and your staff avoid common errors with special procedures:

• Be particularly alert to laboratory, radiology, and pathology reports and to consultation letters from other physicians. These reports and letters should be seen, dated, and initialed by the doctor before being filed in the patient’s chart. Such reports or letters should not be filed without the doctor’s initials.
• Develop and utilize a patient recall file for all tests, procedures, and consultations ordered by the doctor.
• Always call patient noncompliance to the doctor’s attention so that appropriate follow up can be initiated. Notations of actions and copies of letters sent to the patient should become a permanent part of the patient record.
• Document missed and canceled appointments in the patient’s chart, and bring them to the doctor’s attention. Establish a missed appointment follow-up protocol that includes a phone call to reschedule or a post card to alert the patient to the missed appointment.
• Identify a patient’s drug allergies and place this information prominently in the medical record.
• Correct billing or collection errors promptly. If a dispute occurs, stop all billing action until the issue is resolved. If a patient indicates dissatisfaction with a treatment or surgical procedure, discuss with the doctor the possibility of forgiving the outstanding balance.
• Establish collection protocols. Keep collections current and send unpaid patient balances to collection agencies with consistency.

Additional Error Potential
Clinical equipment can result in patient injury if not properly maintained or utilized. These tips can help you and your staff provide a safe environment for patients:

• Know the location and proper use of oxygen and other resuscitative equipment and drugs for emergent conditions.
• Ensure that all medical staff personnel who deal directly with patients are trained in cardiopulmonary resuscitation.
• Check all electrical equipment to confirm that it is properly grounded.
• Report significant equipment malfunctions to the appropriate person in your hospital or office and immediately stop using defective equipment until it is repaired.
• Assign a staff member the responsibility for ensuring that new personnel receive instruction in the correct use of office equipment.
• Maintain a regular schedule for preventive maintenance. Log the activity with a reminder of when the next scheduled maintenance should take place.

Summary
Improving office or hospital procedures and communications in health care are the responsibilities of all personnel. By following the guidelines in this article, you can make a vital contribution to safe patient care.

J4278 8/08

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