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Tube-feeding misconnections fall into the category of medical errors that are so obviously wrong that clinicians think they could never make such a mistake. But feeding tube errors do happen, and they sometimes bring grave consequences.
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Good intentions can backfire when it comes to preparing for RAC audits, cautions Rebekah Plowman, JD, an attorney specializing in health care litigation with the law firm of Epstein Becker in Atlanta.
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The philosophy behind the RAC program at Palomar Pomerado Health (PPH), based in Escondido, CA, is that it is better to find problems yourself before an auditor finds them for you.
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To minimize damage from RAC audits, risk managers should make sure their facilities have highly competent case managers available seven days per week, advises Bill Hammock, RN, BSN, CMC, ACM, vice president and senior consultant in the Global Clinical Health Care Consulting Practice of Marsh in Nashville, TN.
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A pregnant woman contacted her doctor with complaints of decreased fetal movement. He advised her to go to the triage outpatient obstetrical department, where she was placed on a fetal heart monitor and underwent a biophysical profile. The monitor showed a nonreactive fetal heart rate pattern, and the profile confirmed that the fetus was in distress.
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The recent settlement by the University of Medicine and Dentistry of New Jersey (UMDNJ) in Newark has some legal experts concluding that the hospital ended up with a relatively light punishment considering the extent of the alleged billing fraud and the long, contentious litigation that was prompted by a whistle-blower lawsuit.
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Most hospitals already have against-medical-advice (AMA) forms they use when the patient gives the staff a chance, but Helenemarie Blake, JD, a shareholder with the law firm of Fowler White Burnett in Miami, says risk managers should remember that merely having an AMA form and procedure does not guarantee they will be used correctly.
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When patients leave the ED early, what your staff do afterward can make the difference between insulating yourself against a lawsuit and encouraging one, says Robert A. Bitterman, MD, JD, FACEP, a lawyer and emergency physician who is president of Bitterman Health Law Consulting Group in Harbor Springs, MI, and also vice president of Emergency Physicians Insurance Company (EPIC) in Auburn, CA.
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A man presented at an emergency department (ED) complaining of shortness of breath and chest pain. He was seen by an ED physician who ordered blood studies and an EKG.
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Eric Hess, vice president of Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC), provides these examples of how risk management concerns were incorporated into the hospital's recently completed $625 million redesign:
