Incomplete care linked to failure-to-diagnose claims
Surge of volume under ACA could increase risks
Executive Summary
Changes resulting from the Affordable Care Act (ACA) make it especially important for physicians to ensure patients receive continuity of care for acute and chronic conditions. Physicians should consider these practices:
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requiring patients to sign an agreement for "conditions of treatment" at the outset of care;
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having procedures in place to reconnect with patients who fail to keep scheduled appointments or obtain requested laboratory testing;
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counseling patients in the event of continued non-adherence.
Routine blood test results are reported to a primary care physician following a patient's annual physical examination, and they show significantly elevated prostate specific antigen (PSA). The results inadvertently are placed into the office chart, without physician review. The patient is not notified of the results or advised to make a follow-up appointment.
"The patient assumes that 'no news is good news' and fails to call the practice, despite having been instructed to do so at the time of his physical examination," says Richard F. Cahill, Esq., vice president and associate general counsel at The Doctors Company, a Napa, CA-based medical malpractice insurer.
When the results are discovered two years later, the patient has developed an advanced stage of prostate cancer. "The prognosis for a favorable outcome are now severely diminished," says Cahill. This scenario is a common one in many malpractice claims seen recently at The Doctors Company.
Changes resulting from the Affordable Care Act (ACA) make it especially important for physicians to ensure patients receive continuity of care for acute and chronic conditions, Cahill emphasizes. "Millions of additional individuals will be seeking care from a fixed pool of providers, stressing an already-burdened system," he says. "Incomplete follow-up evaluation and care promote greater risks for poor clinical outcomes."
Data goes unaddressed
Too often, an "ad-hoc" process is used to communicate at handoffs, such as when patients go from a rehabilitation facility to outpatient care, says Tejal Gandhi, MD, MPH, CPPS, president of the National Patient Safety Foundation and associate professor of medicine at Harvard Medical School in Boston.
She recommends physicians use a template to ensure key pieces of information are communicated and use "warm" handoffs such as a person-to-person phone call instead of just sending the patient with paperwork.
Gandhi says malpractice suits often result because providers are unable to "close the loop" with test results and referrals. "If you order something, make sure that if it doesn't get done, you know it," she advises. "Breakdowns in that process can lead to missed or delayed diagnosis."
Electronic medical records vary as to their ability to do this well, notes Gandhi, who adds that if a practice uses a manual process, it can in some cases be offloaded to others in the practice so the burden isn't solely on the physician.
Plaintiffs' attorneys frequently attempt to prove that systems errors, breakdowns in communication, or lack of attentiveness by healthcare providers were the cause of the patient's injuries, says Cahill.
"Important patient history or critical laboratory data that is not properly addressed, and that eventually leads to harm, can ultimately result in a jury finding that the care in question was substandard," he warns. (See related story, below, on reducing legal risks.)
