Ambulatory Care Quarterly: Some handoff issues raise risk for malpractice suits
Some handoff issues raise risk for malpractice suits
Stephen A. Frew, JD, vice president and risk consultant with Johnson Insurance Services, a Madison, WI-based company specializing in risk management for health care professionals, says shift changes or "handoffs" in care often are associated with malpractice claims, typically for these three reasons:
1. An interruption in the flow of information from the initial provider to the new provider results in a delay, or sometimes loss of the information entirely.
"Typically, this involves test results or verbal information that is not communicated effectively," says Frew. "Cases often involve an important lab result that came back at shift change that neither physician saw or appreciated."
In this scenario, the newly responsible physician is almost always the one to whom the liability risk falls. "So, it behooves the oncoming physician to be relentless in seeking out any possible test results that might be overlooked," says Frew.
2. Anecdotal information from the EMS crew is lost with a provider change.
Important information, such as loss of consciousness for several minutes at the scene, isn't communicated verbally to the oncoming team by the original staff. EMS has left the ED, and the EMS record is not readily available in the chart.
"That leaves the new physician with a potentially dangerous lack of information," says Frew. "I generally recommend that EMS records be immediately available to the ED physician. Then, EMS and triage notes should be reviewed in detail by the ED physician to avoid being tripped up by data in 'someone else's' portion of the chart."
3. During change of shift, off-going physicians just want to wrap up their cases and leave, while oncoming physicians often are tempted to clear out the carry-over cases as quickly as possible and deal with "their own" patients.
"This somewhat common preference to be rid of the 'leftovers,' and the fact that it is sometimes hard to go back to the beginning to put yourself into the same view as the original physician, can be a recipe for problems," says Frew.
Stephen A. Frew, JD, vice president and risk consultant with Johnson Insurance Services, a Madison, WI-based company specializing in risk management for health care professionals, says shift changes or "handoffs" in care often are associated with malpractice claims, typically for these three reasons:Subscribe Now for Access
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