Between the Cracks

By Jock Hoffman, CRICO

For virtually every physician-patient interaction, your patient’s past is prologue to today’s encounter and tomorrow’s care plan. But coordination of care—even over a brief office visit or hospital stay—is as much of a patient safety challenge as is making a proper diagnosis or carrying out a successful treatment. The path of care from the initial complaint to completion of treatment is far from seamless. Indeed, it is full of cracks—opportunities for losing, misdirecting, or misunderstanding critical information—that pose serious risks for the patient and his or her multiple health care providers. 

Coordination of care risks can derive from patients you see often for chronic care and for those who you’ve never met (e.g., a patient new to your panel being seen in the ED). Most malpractice cases involving poorly coordinated care are those alleging a missed or delayed diagnosis, commonly due to a mismanaged test result, referral, or hand-off. For 522 cases filed against CRICO insureds from January 2005 to October 2010 with care coordination issues, the following three contributing factors were prominent:

• Mismanagement of test results
  (234 cases*/average incurred loss=$1M)
• Mismanagement of referral
  (230 cases/average incurred loss=$852K)
• Mismanagement of hand-off or sign-out
  (255 cases/average incurred loss=$888K)

Those categories comprise myriad communication and documentation factors that prevent multiple caregivers from having a complete picture of the patient’s status and subsequent care needs. Relying solely on memory—yours or the patient’s—is ill-advised; systems that fail to keep everyone (including future providers) well-informed about past care and future responsibilities are equally inadequate. 

At the broad level, CRICO is working with its insured organizations to enhance closed-loop communication of test results and referrals, and improve team communication at key transitions for providers (e.g., hand-offs) and patients (e.g., discharge). For individual physicians and nurses, CRICO and its clinical experts have developed answers to a series of Frequently Asked Questions that address many coordination of care issues.

• Cancer screening
• Coordination of care
• Legal issues
• Medical records
• Office practice
• Patient conflicts

A quick review might help you and your co-providers keep crucial patient information from slipping between the cracks. 

*A single malpractice case may involve more than one factor

Additional Material

• Malpractice Risk in Ambulatory Settings

Original Source, Strategies for Patient Safety