When an accident occurs, don’t make these mistakes

Sometimes, despite your best efforts, an accident occurs with new technology and a patient is injured or dies. Above all, you don’t want it to happen again. Surprisingly, one of the most common mistakes that providers make is "insufficient investigation or lack of response to an error so that it is repeated," says Bruce C. Hansel, PhD, executive director of forensic services at ECRI, a Plymouth Meeting, PA-based nonprofit health services research agency that focuses on technology, risk and quality management, and environmental management.

Stephen Trosty, JD, MHA, CPHRM, director of risk management and CME for American Physicians Assurance Corp. in East Lansing, MI, says that "ultimately, there should be a policy in place after the initial discussion [with the family] so that a group including physicians, nursing, risk management, perhaps engineering, and probably someone from communications/PR can actually get information as it comes in and see what occurred as the investigation occurs."

Avoid these other common mistakes made by same-day surgery providers when an accident happens:

• Don’t point fingers, and don’t delay having staff talk to risk management.

Providers’ first instinct may be to immediately point a finger at someone else, Trosty says. However, the information they have may be inaccurate, he adds.

"Information may come back to haunt you or others. Don’t make assumptions for what occurred before you have information and facts." Contact the risk manager immediately, Trosty says. Have a policy that staff can talk to the risk manager, pastoral care/social services, or the head of their department, who can coordinate the discussion with risk management, Trosty suggests. If the physician or staff members talk to others, they subconsciously may be swayed by what others are saying; in a lawsuit, those discussions may be discoverable, he says. "People are going to be very upset, and they may talk about what they assume occurred," Trosty says. "It may not be accurate, but it may assist plaintiffs in making what is not a legitimate case."

Also consider calling the risk manager at your insurance company, say some sources interviewed by Same-Day Surgery. That person may be able to steer you during the process, they say.

• Don’t ignore the patient and the family.

"It’s not easy [to talk to the patient or family], but you don’t want the patient or family to get the sense they’re being ignored, that people are hiding things, or that they’re not being upfront and honest," Trosty says. "They increase frustrations and can increase the potential for a lawsuit." The physician should explain to the family that there was a negative outcome and express sympathy and concern. "You don’t want people initially admitting liability," he says. Keep the discussion limited and simple, Trosty emphasizes. "What might appear to be the cause of the incident may not end up being the cause." Avoid making any promises about the future, and don’t offer any assurances regarding money or payment issues, Trosty says. Inform the patient and/or the family that an investigation will be conducted and, as information is obtained, it will be shared with them. "The family ought to be provided the name and number of someone they can contact if they have questions or concerns," he adds. The physician is a good contact for any clinically related questions, and social workers, chaplains, or others trained in counseling are good contacts.

As the investigation progresses, you may determine that someone else is the best person to talk to the patient and/or family. "But there should be determination who the spokesperson is so there are not multiple persons working at cross purposes," Trosty says.

• Don’t ignore equipment that was involved.

The most common mistake that providers make following an accident is that they fail to save or sequester all of the medical devices that potentially were involved in the incident, Hansel adds.

Arrange for a knowledgeable independent source to check the functioning of the equipment, Trosty suggests. "Sometimes, the manufacturer will try to get in and get its hands on the equipment. I strongly recommend that not occur. That’s not an independent source," he notes. You only have one opportunity to perform an assessment of the equipment in the actual condition it was in when the incident occurred, Trosty points out.

However, do notify the manufacturer, say sources interviewed by SDS.

• Don’t forget public relations.

Have mechanisms in place ahead of time regarding how you will deal publicly with an accident, Trosty adds. "Get your PR people working on how best to put out information and minimize damage, particularly before all the facts are known," he says.

Issue a written statement prepared by administration, risk management, and your legal counsel, Hansel suggests. It can be read publicly if necessary, preferably by a person experienced in dealing with the media, he says. "Impromptu conferences, extemporaneous speeches, and Q&A sessions should be avoided," says Hansel.

• Don’t ignore needs of physicians and staff.

If a patient has died, the impact can be dramatic on physicians and staff, Trosty stresses. Consider having pastoral care and/or social services available, he says. However, physicians and staff should limit discussions to emotional issues, rather than specifics of the case, with people such as social workers whose discussions may be discoverable in a lawsuit, Trosty says. "Leave the clinical/medical discussions for the peer-review process or investigation process," he advises.