Risk Management Tools & Resources


Close Encounters of the Diagnostic Kind: Improving Provider–Patient Communication During the Diagnostic Process

The model of the diagnostic team, proposed in the Institute of Medicine's (IOM's) pivotal report Improving Diagnosis in Health Care, relies strongly on close collaboration with patients/families as part of the diagnostic process. In its recommendation for implementing a team approach, the IOM notes "Health care professionals and organizations are responsible for creating environments in which patients and their families can learn about and engage in the diagnostic process and provide feedback about their experience."1

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Safety in Numbers: Improving Diagnosis Through Teamwork

In recent years, numerous groups and individuals — including advocacy groups, researchers, healthcare providers, and others — have raised awareness and increased understanding about diagnostic errors, drawing attention to the profound effect that these errors have on patients, families, and clinicians.

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Data Insight: Opioid Treatment — Liability Risks in the Office Setting

It is nearly impossible to read or watch the news without mention of the opioid crisis. From patient addiction to death from overdosing, opioid abuse can have tragic outcomes. Further, when these unfortunate events are related to medical care, they can result in malpractice allegations against healthcare providers and organizations.

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Tips for Presenting a Patient With a Pain Management Contract

Pain management contracting is one strategy that healthcare providers can employ to help manage the risks associated with treating patients who take opioids. A pain management contract is a type of behavior contract, which is an agreement between a patient and healthcare provider or organization that defines expectations related to behavior, conduct, communication, and/or treatment. Using a pain management contract can help set standards and expectations in relation to a patient's care, the provider–patient relationship, and appropriate use of opioid therapy.

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CASE STUDY: Patient Overdoses and Dies After Inappropriate Opioid Prescribing

The patient was a male in his late thirties with a history of significant orthopaedic injuries and a previous narcotic and heroin dependency. He presented to the emergency department (ED) at a rural critical access hospital with complaints of low back pain radiating down both legs. He was diagnosed with muscle spasms, treated with non-narcotics, and referred to a family medicine physician.

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10 Strategies Healthcare Organizations Can Employ to Address Bias in Pain Management

Bias in pain management is an ongoing and complex issue in healthcare. Research has shown disparities in pain management in relation to race, ethnicity, gender, and socioeconomic status. Complicating matters, many instances of bias are implicit, creating a need not only to address the bias, but also to raise awareness of its existence.

Recognizing and addressing bias are imperative. Failure to treat pain or poorly treated pain can interfere with how patients recover from illnesses and procedures, which can potentially cascade into numerous patient safety and financial consequences, such as increased morbidity, hospitalizations and readmissions, and liability exposure. Additionally, bias in pain treatment may lead to misdiagnosis, unnecessary patient suffering, lack of patient trust in healthcare providers, communication lapses, and failure to provide patient-centered care.1

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CASE STUDY: Hasty Prescribing of Pain Medication Leads to Patient Overdose

The patient was a male in his mid-forties who suffered from chronic pain of unknown etiology. He was a long-time patient of Dr. B, a MedPro-insured family practice physician. Dr. B referred the patient to an anesthesiologist, Dr. M, who subspecialized in pain management.* Dr. M started the patient on a fentanyl patch (25 mcg/hour), and then gradually increased the patient's dose to 100 mcg/hour.

After not being evaluated or treated by Dr. B for some time, the patient called the family physician's office and requested a refill for his fentanyl patch. He stated that he was leaving town and was unable to get in touch with Dr. M to secure the refill. Dr. B's medical assistant prepared the prescription, and Dr. B signed it.

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CASE STUDY: Insufficient Imaging and Poor Communication Complicate Tooth Extraction

The patient, a female who had limited English proficiency (LEP), saw Dr. B, an associate in a busy general dental practice, for extraction of tooth number 32. A dental assistant had taken a periapical X-ray that depicted most of the root but missed the last few millimeters of the apex. The tooth was partially impacted, accessible to the oral cavity, and possessed fused conical roots.

Because Dr. B had removed hundreds of teeth in similar circumstances, she was confident that she could extract the patient's tooth without difficulty. Further, she did not want to take more X-rays and expose the patient to additional radiation.

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