Risk Management Tools & Resources

 


CASE STUDY: Delayed Cancer Diagnosis Results in Malpractice Liability for Physician Assistant and Supervising Physician

CASE STUDY: Delayed Cancer Diagnosis Results in Malpractice Liability for Physician Assistant and Supervising Physician

Case Details

The patient was a 53-year-old male who presented to an internal medicine practice because he had a lump in his right groin. The patient had been going to the practice for years and typically saw one physician assistant (PA) for most appointments. Over the years, he had seen the PA for various conditions, such as allergies, abdominal pain, cardiac issues, respiratory infections, and hypertension, among others.

At the patient’s visit to evaluate the lump in his groin, the PA ordered a CT scan. The test was completed, and the results showed an enlarged inguinal lymph node. Whether these results were communicated to the patient is unclear; although receipt of the results was documented in the patient’s record, no documentation from that time indicates whether the patient was notified about the results or next steps.

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Data Insight: Triage Pitfalls in the Emergency Department

Communication issues, particularly among healthcare providers, are not unusual in malpractice cases; in fact, they are noted in approximately one-third of all cases. Various scenarios across care settings illustrate the importance of thorough communication among providers — yet few highlight it as well as cases occurring in the emergency department (ED), where decisions are made quickly and little time is available to correct miscommunication.

In most EDs, patients are initially triaged by nurses prior to seeing physicians or advanced practice providers (such as nurse practitioners or physician assistants). However, the benefit of triage and having more than one provider evaluate patients might be forfeited if communication breakdowns occur.

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Speaking Up for Patient Safety: Techniques to Support Assertiveness

Speaking Up for Patient Safety: Techniques to Support Assertiveness

Laura M. Cascella, MA

Speaking up about risks, concerns, and errors in patient care is an essential component of patient safety. Although voicing concerns may seem like a reflexive response for healthcare providers and staff, barriers can prevent it from happening. Fear, intimidation, lack of confidence, power structures, and other factors can thwart individuals' efforts to assert concerns. These issues can permeate healthcare organizations that permit or do not constructively address disruptive behavior, bullying, retaliation, and blame.

To combat a toxic environment in which healthcare providers and staff do not feel empowered to raise concerns, healthcare leaders, providers, and staff must establish and support a culture of safety. This crucial effort is particularly important as healthcare delivery models expand to include more types of providers and providers who are working more closely together.

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Breaking Down Communication Barriers in Collaborative and Team-Based Care

Breaking Down Communication Barriers in Collaborative and Team-Based Care

Laura M. Cascella, MA

Successful communication among healthcare providers has always been a critical element of patient safety. Yet, in recent years, the importance of good communication has become even more pivotal with the growing emphasis on collaborative and team-based care. As healthcare delivery has evolved, the paradigm of the solo practitioner has given way to more complex healthcare systems and multidisciplinary teams that include doctors, nurse practitioners, physician assistants, nurse anesthetists, surgeon assistants, clinical nurse specialists, and other clinical and nonclinical roles.

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The Essential Role of Informed Consent in Robotic Surgery

The Essential Role of Informed Consent in Robotic Surgery

Laura M. Cascella, MA

Direct-to-consumer marketing of robotic-assisted surgery (RAS) has sparked interest in this technology among patients who may be enticed by statements about quicker recovery periods, less pain, smaller scars, lower infection risk, etc.

However, marketing and advertising efforts might paint an incomplete picture of the benefits and risks of RAS, thus pointing to the essential role of informed consent in the treatment of patients who are considering robotic procedures. Just like with any other type of surgery, informed consent for RAS should involve a process undertaken by the treating surgeon to educate the patient about his/her procedure.

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Risk Perspectives in Telehealth: Informed Consent

In recent years, technological advancements have helped improve access to and convenience of care. Healthcare delivered via telecommunication technology — i.e., telehealth — has become an increasingly popular and viable option for patients. Yet, even with these advancements, certain aspects of traditional medical care remain vital, including informed consent.

Informed consent is a process that is used to educate patients about treatments and procedures, their potential benefits and risks, and alternative options. The level of detail associated with the informed consent process should depend on the complexity and risks of the procedure or treatment involved.

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CASE STUDY: Test Tracking and Follow-Up Failures Lead to Delayed Cancer Diagnosis

The patient was a 42-year-old female with a history of HPV, infertility, yeast infections, and abnormal Pap smears. She presented to her OB/GYN's clinic for a routine Pap smear. It had been a little more than 2 years since her last Pap smear, which had been negative. The tissue sample was taken and, for reasons not known, sent to a private diagnostic laboratory, rather than the hospital laboratory (as was the normal practice). The laboratory returned findings of endocervical adenocarcinoma in situ.

Dr. A reviewed the test results and entered the findings into the electronic health record (EHR). He then gave the results to a nurse and instructed her to contact the patient to schedule an appointment as soon as possible. Unfortunately, no one from the clinic contacted the patient about the abnormal results.

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Copy and Paste: The EHR Documentation Gremlin

The practice of copy and paste — also called cut and paste, cloning, and carrying forward — is one of the most common and problematic documentation issues associated with electronic health records (EHRs). Copy and paste refers to electronically lifting information from a previous entry in a patient's record and placing it in the current entry. It also refers to copying information from one patient record to paste into another, such as through the use of boilerplate language. Automated functions within EHR systems facilitate copy and paste because of the ease with which users can grab and move content.

A survey done by the Medical Professional Liability Association (formerly PIAA) identifies copy and paste as the leading trend in EHR-related malpractice allegations, and a claims data analysis facilitated by CRICO Strategies also points to copy and paste as a top user error contributing to malpractice lawsuits.1

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