Regulations, rules, litigation, and medical errors are not the most popular topics for the busy clinician. Most of us would rather gargle nuclear waste than spend a precious evening reading about these issues that plague the pure and honorable practice of medicine. However, we avoid such matters at the peril of our patients’ safety as well as our own personal and professional well-being.
Since few (if any) of us will invest in a treatise the length of War and Peace on the subject, I have assembled the following short list of “10 Medical-Legal Basics Every Provider Must Know” for the busy physician, nurse, and advanced practice clinician.
1) Anatomy of a Medical Negligence Lawsuit
If you have already been sued, you can skip this topic, as you have already lived through the grueling litigation process. For those of you who have avoided a malpractice suit to date, having a working knowledge of the medical-legal process is a must. In a nutshell, you should understand the concepts of negligence, standard of care, expert witnesses, motions, discovery, settlements and trials. Knowing what you might face in a malpractice suit should inspire you to document thoroughly, prevent medical errors, and improve patient safety.
2) Cognitive Errors in Medicine
The complex and process-rich practice of medicine is rife with risk for errors. When they occur, the compelling question that needs to be answered is: “What was the clinician really thinking?” The topic of “cognitive errors” approaches medical errors from a new and challenging viewpoint by examining the thought processes that influence clinical decision-making. Real case examples can be used to illustrate several types of cognitive errors that result in delayed or missed diagnoses, including anchoring, premature closure, diagnostic momentum, search satisficing, and many more.
3) Communication Strategies to Improve Patient Safety in High-Risk Situations
Communication mishaps are the root cause of many mistakes and the resultant morbidity and mortality. Emergency medicine, critical care, and surgery represent areas of high-risk practice that are particularly prone to communication errors – between doctors, nurses, patients, and families. It is critical to know how and why they occur and learn effective techniques to prevent them. Safe handoffs, SBAR technique, and automated systems may sound like something you might hear in an air traffic control tower, but they are essential strategies to improve patient safety in high-risk situations.
4) Confidentiality of Medical Information: Complying with HIPAA & State Law
If only it were as simple as keeping your keyboard quiet and your mouth shut when it comes to patient privacy and protected healthcare information. Breaches in patient confidentiality are never a good thing, and compliance with existing rules and regulations is paramount to avoid violations resulting in fines and penalties. Practitioners should know the basics of HIPAA and state law.
5) Duty of Care: The Provider-Patient Relationship
What is your duty in the provider-patient relationship? In its simplest terms, it is one of mutual agreement: the provider agrees to examine and treat the patient while the patient agrees to be examined and treated. Sometimes your legal and ethical “duty” to a patient is not so obvious, such as when you are a specialist on call at the hospital, providing telemedicine services, supervising advance practice clinicians, or considering terminating a patient relationship. Most of us did not learn the concept of “duty” in medical training, but it is never too late to go back and grasp this fundamental concept.
6) EMTALA Basics
No, EMTALA is not a Scandinavian rock band; it is a complex federal law that applies to hospitals and emergency departments and all the providers, nurses, on-call specialists and hospital administrators who work there. (EMTALA = Emergency Medical Treatment & Active Labor Act). All hospital personnel should understand the basic concepts of EMTALA before CMS invades your hospital with an investigation that could result in fines or exclusion from participation in federally funded healthcare. If your hospital is hit with an EMTALA investigation, rest assured that educating everyone in your system about EMTALA will no longer be optional, it will be required.
7) Handoffs, Transitions, Discharges: Key Moments in Patient Care
We are just recently recognizing the importance of patient handoffs and transitions that occur thousands of times each day. Unfortunately, healthcare handoffs are catalysts for communication errors that result in significant adverse events and patient harm. The discharge process has been overlooked as a key transition point in the continuity of patient care. Providers and hospitals that master patient handoffs, transitions and discharges are also those that succeed in improving patient outcomes and reducing unnecessary hospital readmissions.
8) Never Events
The term “Never Events” is an oxymoron because they still occur despite all efforts! The cost to society in terms of patients harmed, lives lost, and dollars spent is staggering. There are dozens of Never Events grouped into 7 categories – surgical, product or device, patient protection, care management, environmental, radiologic and criminal. Evidence-based guidelines, accepted best practices, and standardized communication techniques are means to correct (and avoid) these serious and needless medical errors.
9) Patient Satisfaction
Even if you learned impeccable manners from your parents or finishing school, you still need to know that healthcare is an increasingly consumer-driven industry and patients can pick and choose where they receive healthcare. As a result, delivering a positive patient experience is paramount to the survival and success of healthcare delivery systems. Despite high public demand and potential hospital revenue loss from poor patient satisfaction scores, we are doing a poor job of training our medical community how to successfully satisfy our patients. A video-based 10-Step Patient Satisfaction Checklist can be used to train all staff by showing examples of both the wrong way and the correct way to communicate with patients to achieve the optimal patient experience.
10) Prevention of Medical Errors
For centuries, providers have practiced medicine by following the age-old Hippocratic rule of “Do no harm.” Unfortunately, preventable medical errors and patient harm are caused not by bad intentions or insufficient training, but by flaws in the healthcare delivery system and processes used by providers. Providers must be adept at preventing errors in several key categories, including surgical, medication, communication and teamwork, and transition and handoff, as well as errors related to patient safety technology. Practitioners should be able to: use the Universal Protocol to prevent common surgical errors such as wrong-patient, wrong-site, and wrong-procedure events; employ strategies to prevent medication errors; and illustrate how the process of root cause analysis can be used after a sentinel event to make effective changes in the healthcare delivery system.
Read the medical-legal equivalent of War and Peace if you can find it and have months of free time to spare. For the rest of us, a case-based, targeted excursion through this “Top 10” list should satisfy our need for an overview of basic regulations, rules, litigation processes, and principles of medical errors that every provider should know.
