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 opened between 2012 and 2021 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 half of all cardiology claims — most notably in surgical treatment/procedural allegations and medication-related allegations.³

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 thorough 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. Various communication techniques can help standardize information exchange and prevent information from slipping through the cracks.
• 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 patient follow-up.
• Make sure test-tracking and follow-up protocols are timely and consistent. Policies related to tracking should aim for zero tolerance in variation.
• Establish requirements for using tools, checklists, and forms as part of care coordination and handoff processes.
• Define expectations for documenting 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 communication policies, and ensure it is applied consistently across the organization.

Care coordination and handoffs involve many components and individuals as well as complex logistical processes. As a result, healthcare providers and 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 adverse events and patient harm.

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
• Preventing Patients From Slipping Through the Cracks
• Risk Q&A: Handoffs and Signouts

Endnotes

¹ Leonard, M., Graham, S., & 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 CRICO Strategies. (2015). Malpractice risks in communication failures: 2015 annual benchmarking report. Retrieved from www.candello.com/Insights/Candello-Reports/Communications-Report

³ MedPro Group. (2023). 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 www.medicaleconomics.com/view/seven-steps-managing-transitions-care

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