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Dr. Susan Woodmansee, MD, JD, is one of The Mutual’s physician risk educators who feels passionate about enhancing patient safety and reducing professional liability exposure in medical practice. In the following article, she shares her insights on how communication is essential to mitigate risk during interfacility transitions of care.
Communication is paramount when it comes to reducing professional liability exposure with interfacility transfers. Sending providers have a duty to provide solid communication to the receiving provider and reduce unnecessary delay in diagnosis and treatment. This is particularly important when there is a question of a time sensitive diagnosis such as (but not limited to) sepsis, necrotizing fasciitis, or compartment syndrome. A receiving provider has a duty to perform their own evaluation of the patient and should have a low threshold for ordering additional studies and consultations at their own facility. In cases with bad outcomes where these duties are not met, a plaintiff will most likely prevail in proving a case of medical malpractice.
A child was treated for a laceration to the leg. He subsequently returned two more times with signs of infection and severe pain. The patient received antibiotics and transfer to a facility with a pediatric unit was initiated. After the transfer was accepted by the pediatric hospitalist, the nurse at the sending facility paged the transferring ED physician to report the foot was cold and they were unable to palpate a pedal pulse. The original transferring physician had gone off shift, and no updates were reported to the transfer team or receiving facility regarding the patient’s change in status. At the receiving facility the patient was evaluated by the hospitalist who appreciated a concerning exam and worsening condition. Surgery was consulted. The patient went through multiple surgeries and interventions for a necrotizing soft tissue infection and compartment syndrome, ultimately resulting in the amputation of the entire leg. This case resulted in litigation.
The ideal communication process is a real-time Provider-to-Provider model where the sending provider communicates verbally with the accepting provider. Some facilities utilize an optimized centralized transfer center which shares relevant clinical information between sending and receiving providers along with transferring personnel. Yet, a reality of clinical practice is we are not always working in the ideal situation. An additional complicating factor of transfers is the sending and/or receiving provider often go off shift prior to the hand-off of care and arrival of the patient. This leaves the subsequent receiving provider reliant on the documentation of both the initial sending and accepting physicians. Beyond the regulatory requirements, documentation should include specific clinical concerns, particularly for the high risk/time sensitive patient. One final but no less important aspect of communication when it comes to transfers, keep the patient/family informed to clarify timing and expectations, supporting a better perception of their care.
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1. Communication between sending and receiving providers is paramount when it comes to reducing professional liability exposure with interfacility transfers.
2. Sending providers have a duty to provide solid communication, verbal and written, to the receiving provider to reduce unnecessary delay in diagnosis and treatment.
3. Communication with the patient and/or family keeping them up to date and clarifying expectations can help mitigate risk associated with transfers.
Congratulations to Dr. Anum Niazi at Community Hospital in Munster, Indiana for winning the last quarter's raffle!