Executive Summary
Insufficient communication between providers is often a contributory cause in malpractice lawsuits that name more than one provider.
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Providers must be able to request information from other providers who are treating the same patients.
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Interdisciplinary rounds with a "culture of inclusiveness" encourage individuals to speak up.
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In the outpatient setting, physicians can call a colleague to obtain a different perspective.
Taking a "pause point" to consult with another provider can prevent a potential bad outcome and malpractice claim, according to Peter J. Pronovost, MD, PhD, FCCM, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore, MD.
"What classically happens is that physicians make a plan — 'This is sepsis, and I will treat it' — but they get new data that suggests the plan isn't the right one," Pronovost says. "Too often, we don't build in those pause points to say, 'Do we need a new plan?'"
A 55-year-old, obese female with poorly-controlled Type II diabetes who sees a primary care provider, endocrinologist, orthopedic surgeon, cardiologist, and ophthalmologist is a typical patient in an aging population, says Kathleen M. Roman, MS, a Greenfield, IN-based risk management consultant. "Too often, providers make important care decisions without any personal contact with the others, other than reading whatever information may be retrievable within the records," says Roman.
A review of 2,466 claims between 2007 and 2011 by The Doctors Company found that communication failures among physicians contributed to 7% of patient injuries.
If one doctor knows something that might assist or influence care about to be provided by another, it doesn't always occur to them to pass along that information.
"Often, they assume that it's the patient's duty to pass the information along," Roman says. Patients don't always have the clinical knowledge or the communication skills to provide that information to medical providers, however.
Naming multiple providers
Insufficient communication between providers is often a contributory cause in malpractice lawsuits that name more than one provider, reports Roman.
"When the facts of the case are analyzed, it often becomes apparent that the lack of communication led to misassumptions, incompatible treatment or medications, delays in diagnosis or treatment, or a variety of other factors that contribute to patient injury," she says. Roman recommends that practices develop processes that allow Provider A to automatically send reports, test results, and consult notes to requesting Provider B. At the same time, Provider A needs to be able to request information from providers outside the corporate structure who are treating the same patients.
"This type of communication can prevent potentially dangerous errors such as duplication of tests, incompatible medications, and lack of access to test results," says Roman.
Consult with others
Interdisciplinary rounds should have a "culture of inclusiveness" that encourages people to speak up, advises Pronovost.
"When you are uncertain what's going on, or a patient is getting sicker, call a bedside huddle," he says. "Get all the team involved."
The same approach can be used in the outpatient setting by calling a colleague to get a different perspective or by including the patient or family, Pronovost says. "Physicians shouldn't hesitate to admit they don't know what's going on and invite the input of others," he says. Pronovost often says to colleagues, "Can you help me understand what you are seeing that makes you think that X is going on? From what I see, I am seeing a different picture."
Pronovost adds that the same behaviors that allow for low errors and safe care result in high patient satisfaction scores.
"If you get this right, you feel good and patients feel good, and you are more effective because harm is less," he says.
SOURCES
- Peter J. Pronovost, MD, PhD, FCCM, Senior Vice President for Patient Safety and Quality/Director, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. Phone: (410) 502-3231. Fax: (410) 502-3235. Email: [email protected].
- Kathleen M. Roman, MS, Roman Empire Consulting, Greenfield, IN. Phone: (317) 326-7543. Email: [email protected].
