The Mutual supports the collaborative care model utilized at many Vituity practice locations and appreciates insights shared on patient safety best practices from experienced physician risk educators. The Mutual contracts with physician risk educators that have years of knowledge gleaned from time worked in the trenches as well as their studies on risk reduction. We asked these educators a question and want to share the response. Can you summarize a culture, team dynamic, or supervisory practice you utilize to prevent adverse patient outcomes? Can you recommend any patient safety resources to share?
Advanced Practice Providers (APPs) have a broad set of knowledge and skills that allow them to manage a myriad of ED patients. As a supervising physician and former medical director, I have learned a collaborative environment with clear expectations is imperative for not only high-quality patient care and efficiency, but also for our team culture.
Our site used Vituity's recommendations to develop a set of supervision guidelines to ensure physicians are involved in the care of higher-risk patients. From my perspective, guidelines identify patients with high potential for patient deterioration and unexpected outcomes; and can serve as a resource to guide which patients need physician consultation or intervention. Having worked at several sites over the years, I've seen variations of guidelines depending on the local practice patterns and APP's degree of comfort and experience managing higher ESI patients. Having a set has been imperative no matter where I have worked. Yet, I also learned just having a set of guidelines is simply not enough. It is equally as important the expectations and reasoning for using them is understood as value-added by all: All APPs and physicians. At our site we review our guidelines as part of our provider onboarding process and include this topic regularly in department meetings to reiterate the importance. In doing this, we limit pushback and maximize their efficacy. I believe we also minimize our risk exposure.
Beyond the guidelines, a practice I personally use to reduce my risk is making sure I am approachable. As a supervising physician, I want our APPs to discuss a case with me if they feel something is not going as planned, if the patient is sicker than anticipated, or if they simply want a second set of eyes and ears. Not only does this ensure appropriate patient care, but this fosters a collaborative dynamic between us that extends to improved patient care far beyond the single encounter.
Vituity Risk worked with a committee of APP leadership, physician risk leadership, and The Mutual's patient safety team to outline patient categories that present as inherently higher risk clinical scenarios. Whether preventable or not, unexpected bad outcomes increase potential for professional liability exposure. The Mutual recommends use of supervision guidelines to improve patient outcomes in higher risk encounters, thereby reducing risk for all involved.
1. Each site should establish risk management guidelines aligning with the hospital or health system for supervision which includes how advanced providers receive oversight from the supervising physician(s).
2. APPs should document consultations with their supervising physicians in the medical record even in cases where an in-person evaluation by the supervising physician was not necessary.