Patient satisfaction is a best practice
Patient satisfaction is a best practice
'It's hard to hate someone who's been good to you.'
If ED physicians and nurses could choose only one strategy for avoiding lawsuits, it should be to keep patient satisfaction levels high, say several experts interviewed by ED Management.
CEP/MedAmerica, an Emeryville, CA-based provider of ED management and staffing solutions, has conducted internal research regarding malpractice risk. "We track patient satisfaction, door-to-provider time, and medical malpractice cases per 20,000 visits," says Martin E. Ogle, MD, regional director for the southern division. "There is a definite correlation between increasing patient satisfaction and decreasing the medical malpractice frequency."
In fact, there is "almost a linear relationship between the highest and lowest levels of satisfaction," he says. "We've seen up to a threefold reduction in the number of claims over a million patient encounters," Ogle reports.
Gregory Henry, MD, FACEP, risk management consultant for Emergency Physicians Medical Group in Ann Arbor, MI, says, "It's hard to hate someone who's been good to you. The smart ED doctor understands you have to get very close to the family, particularly when things are going badly." He reports that as much as 50% of what he does is "schmoozing."
Corey M. Slovis, MD, FACEP, FACP, FAAEM, chair of emergency medicine at Vanderbilt University Medical Center in Nashville, TN, agrees. "For so long, older doctors — me included — thought the measure of our job was how smart we were, how expert we were in emergency care," he says. "I now have begun to appreciate that you have to layer on customer service and both perceived and delivered quality." In short, he says, delivering the right dose of the drug at the right time "does not make you a great ED doc."
Any patient can have a bad outcome, says Tom Syzek, MD, FACEP, MD, FACEP, director of risk management for Dayton, OH-based Premier Health Care Services. "Who gets sued? The doctors and nurses the patient does not like," he says.
The personal approach is no less important for nurses, adds Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles. "One of the best ways to try to prevent complaints is to be very attuned to patients and their perspective," she says. Building personal skills that enable you to relate to patients helps you anticipate and avoid problems, she says. "The best way to do that is to constantly ask yourself why a person might be doing what they're doing and try to understand where the person is coming from," Contino notes.
Ogle says, "For me, it's also the simple stuff like being your optimized self; coming in well rested, focused; not taking calls from your broker; not texting and 'tweeting'; and focusing on your patients' needs. It's not rocket science, but I can't tell you how many times people have personal crises, and there is a real negative impact on their medical practice."
Nursing Best Practices Can Minimize Complaints
Source: Diana S. Contino, Deloitte Consulting, Los Angeles. |
Seek out aids to risk prevention ED managers should take advantage of the tools available to help them reduce the risk of lawsuits, says Tom Syzek, MD, FACEP, MD, FACEP, director of risk management for Dayton, OH-based Premier Health Care Services. "Identify the appropriate tools for paper or dictation templates, or, with emergence of electronic health records, work with vendors and select a system that not only optimizes billing and data capture, but has a built-in risk overlay: prompts, resources, and reminders that will appear at the bedside," Syzek advises. For example, if there are severely abnormal vital signs at the end of the encounter, a system "pop-up" should remind you not to let this patient go home unless you address those findings, he says. In addition, you should include a performance improvement program as part of your risk management program, Syzek says. "Generally, that means some type of chart review, a chart audit system," he says. "Nurses, for example, should do triage audits, to ensure the proper triage levels are being assigned, since having a patient triaged to a lower acuity level than they merit could have adverse consequences. You could pick any piece of the ED process and build around it. For example, the whole department could do a stroke audit to see if documentation and clinical practice match up with established clinical guidelines." |
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