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The Role of Risk Management in the Physician-Patient Relationship

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Healthcare is constantly evolving, keeping risk management personnel on their toes, researching old and new trends, and adapting methods and strategies that can be used as resources and tools for physicians, practitioners, and their staff.

At the Cooperative of American Physicians, our goal is to prevent issues by utilizing these risk strategies across the industry, reducing adverse events and claims. We want you to be your patient’s superhero— without risk and stress — and CAP’s Risk Management and Patient Safety Department can help. This includes increasing our member’s awareness of proactive-related regulations and providing practice surveys to members on a consistent basis to ensure the practices are equipped with the most up-to-date arsenal of protection. We also staff a 24/7 emergency hotline to encourage early intervention as a means to help prevent an adverse event from becoming a claim, and even walk members through the safest ways to respond to events.

Risk management strategies can not only protect all stakeholders involved in your practice but can save substantial amounts of money by putting safeguards in place. These safeguards can create a less disorganized practice. Below is a list of current problems that continue to occur, and ways to practice implementing safeguards that can protect your practice from a malpractice claim:

1     Informed Consents and Informed Refusals

Informed consents and refusals are in place for a variety of reasons. They help the patient fully understand the procedure that is being done, they detail how and what was said by the physician, and they show proof that a patient accepted all the risks of that procedure or did not accept the risks of the procedure after receiving an in-depth education of the procedure.

a)    Informed consents and refusals should name the physician educating the patient. It is recommended that the physician who completes the consent or refusal sign the form to ensure their confidence in the inform consent or refusal that took place. Although not required, the physician’s signature, along with a witness’ signature, can be the key in determining that the patient understood and signed the consent or refusal on his or her own accord. Documentation in the patient’s chart could reflect a phrase similar to “Informed consent (or refusal) performed on date at time” and the copy of the informed consent/refusal given to the patient and scanned into the chart.

b)   It should be completed in the practice before hospital pre-op and maintained in the patient’s office record.

c)    The form should list common terminology and medical terminology, specific and general risks for the procedure, alternatives to treatment, and risks of not getting any treatment.

2     Supervision of Physician Assistants and Nurse Practitioners

Supervising physicians receive claims against them when their supervised advanced healthcare professionals have an adverse event or a claim. The common response to a majority of these cases is, “I didn’t do anything wrong, my PA or NP didn’t keep me in the loop.” As the supervising physician, having open communication with your delegated staff is very important. Be an active component in the physician/PA or NP team and make sure the supervised practitioner is aware of the policies and procedures in your practice. Those who work together in synchronicity are the safest teams in preventing patient injury and malpractice claims.

a)    When hiring a PA or NP, complete a Delegation of Services Agreement or Nursing Standardized Procedure for each practitioner.

b)   Board requirements for supervising a PA or NP differ slightly. Get familiar with the requirements for any practitioner that is brought on board.

c)    Remember, there are limits to the amount of advanced practitioners that may be supervised by one physician. Keep the ratio 1:4 in mind, one physician per four advanced practitioners. Any more than that, and it really wouldn’t be supervising.

It all comes down to this: At CAP, we are here for you. Contact the Risk Management Department to schedule a practice survey to get the tools your practice may need or call the CAP Hotline at 800-252-0555 to address immediate needs of your practice. As a member, you are not, and will never be, alone!

 

Steven Blackburn is a Senior Risk Management and Patient Safety Specialist for the Cooperative of American Physicians. Questions or comments related to this article should be directed to sblackburn@CAPphysicians.com.

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