Risk Management Tools & Resources


The Essential Role of Informed Consent in Robotic Surgery

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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CASE STUDY: Improper Management of Bariatric Surgery Patient Leads to Suboptimal Outcome

A patient underwent laparoscopic Roux-en-Y gastric bypass. During the immediate postoperative days, the patient experienced tachycardia and significant abdominal pain. An abdominal computed tomography (CT) scan revealed fluid in the abdomen, but the results were not immediately relayed to the surgeon.

Over the next 2 days, the patient's condition deteriorated, but neither the nursing staff nor the lab directly notified the surgeon about the critical CT scan results. Ultimately, the patient required surgery after developing respiratory distress, metabolic acidosis, septic shock, and acute renal failure.

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Bariatric Surgery Malpractice Allegations: What Claims Data Show, and Ways to Reduce Risk

Obesity is a well-known health concern in the United States. Often referred to as an epidemic, obesity affects about 36 percent of U.S. adults — more than double the number affected just 30 years ago.1 Bariatric surgery has emerged as an effective treatment option for many individuals who suffer from obesity, and the number of these procedures has increased over the years.

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CASE STUDY: Failure to Diagnose Pulmonary Embolism Results in Patient's Untimely Death

The patient was a male in his late twenties who suffered from obesity, asthma, high blood pressure, and Crohn's disease. He also had a recent history of surgical repair for a femur fracture. The patient visited his regular family medicine practitioner in October and was treated for rhinitis and sinusitis. His pulse oximetry reading at the time was 99 percent.

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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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