Ineffective Communication in Cardiology: Addressing a Persistent Risk Factor in Malpractice Claims
Laura M. Cascella, MA, CPHRM
Providing coordinated and competent patient care involves precision at many points in the clinical process, particularly when sending and receiving information. Although information transfer seems like a fairly straightforward process, the complex and dynamic nature of healthcare presents numerous communication obstacles.
As a result of these obstacles, ineffective communication among healthcare professionals is one of the leading causes of medical errors and patient harm.1 Further, analysis of malpractice claims shows that communication is a common contributing factor in claims across various specialties.2
Cardiology is no exception; an evaluation of MedPro Group cardiology claims closed between 2009 and 2018 reveals that communication is the second most prevalent malpractice risk factor for this specialty, trailing only clinical judgment. In the 10-year period analyzed, communication issues were identified in 48 percent of all cardiology claims — most notably in medication-related allegations and diagnosis-related allegations.3
Communication lapses among healthcare providers are noted as a particular area of vulnerability in cardiology (more so than lapses between providers and patients). Communication missteps and errors might occur at various points in the patient care process, such as during coordination of care or transitions of care (handoffs) among multiple providers and medical staff members. These providers and staff members might be working in the same practice or coordinating care across various organizations.
Further, the scenario in which information is exchanging hands can vary. For example, a clinician might be providing coverage for another practitioner, ordering diagnostic procedures, giving or receiving a referral, or participating in multidisciplinary care. Regardless of the situation, effective care coordination and handoffs require careful verbal and written communication among providers and healthcare facilities, accountability for assigned roles, ownership of established processes, and engagement with patients and other providers.4
Cardiology practices can implement various policies to support continuity and coordination of care, improve patient safety, and potentially reduce liability exposure. Examples of these policies include the following:
- Clearly establish duty of care and clinical responsibilities for all providers involved in the patient’s care, including expectations for verbal and written communication. For example, who is communicating information to the patient?
- Define the specific types of information to communicate during care coordination or handoffs, such as the patient’s current status, medical history, family history, known conditions, allergies, medication list, test/lab results, treatment information, next steps, and contingency plans. A communication technique, such as I PASS THE BATON, might be helpful to incorporate into communication protocols.
- Support thorough and ongoing communication between physicians, advanced practice providers, and clinical staff (e.g., through electronic mediums, regularly scheduled meetings, etc.).
- Define appropriate processes for referrals and consultations, such as how the practice intends to handle urgent communication, consultation reports, informed consent, and follow-up.
- Specify a protocol for communicating pertinent clinical findings or critical test results.
- Establish requirements for using tools, checklists, and forms as part of the care coordination process.
- Define expectations for documentation of care coordination and handoff communication in the patient health record.
- Ensure providers and staff members receive training on care coordination and handoff protocols, and encourage providers and staff members to report barriers associated with these protocols.
- Determine the practice’s protocol for auditing compliance with care coordination and handoff policies.
Care coordination and handoffs involve many components and individuals as well as complex logistical processes. As a result, healthcare providers and clinical staff might feel limited in their ability to manage all of the moving parts and effect change, especially when working with individuals and groups outside of their own organizations. However, taking proactive steps within the practice to address gaps in communication and enhance continuity of care can help improve quality and potentially prevent an adverse event.
For more information, see the following MedPro resources:
- Breaking Down Communication Barriers in Collaborative and Team-Based Care
- Checklist: Reducing Risks Associated With Patient Handoffs
- Risk Q&A: Handoffs and Signouts
Endnotes
1 Leonard, M., Graham, S., and Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13, 85–90.
2 Ruoff, G., Hoffman, J., et al. (2016). Malpractice risks in communication failures: 2015 annual benchmarking report. Cambridge, MA: CRICO Strategies.
3 MedPro Group. (2020). Cardiology: Claims data snapshot. Retrieved from www.medpro.com/documents/10502/5086243/Cardiology.pdf
4 Woodcock, E. W. (2014, March). Seven steps for managing transitions of care. Medical Economics. Retrieved from https://www.medicaleconomics.com/view/seven-steps-managing-transitions-care
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