Healthcare providers go into the profession to take care of people and help them get well when they are sick or injured. Unfortunately, with all good intentions, sometimes bad things happen. Whether it’s a post procedure complication, a medical error or other significant adverse event, the way the situation is managed after the fact can either derail or provide motivation for the patient or family to file a lawsuit. If you are a retail broker specializing in healthcare professional liability, your client will have fewer lawsuits if they follow these guidelines – feel free to share this information with them.
Here are some examples of adverse events
Surgical complication: In our first example, a patient went into a hospital for an elective laparoscopic cholecystectomy and had been consented for the procedure with a clear explanation of the risk of a bile duct injury. The patient unfortunately did suffer from a bile duct injury and required an extensive hospital stay, including several days in the ICU. After the procedure, the surgeon told the family that there was a complication with her bile duct and that she would be going to the ICU and that she would be well taken care of but offered no other information before he promptly walked away. The family found out upon visiting the patient in the ICU that the surgeon had transferred her care to the intensivists – who were planning her transfer to a tertiary care medical center. The family did not see the surgeon again during her stay, nor did he follow up with the family to inquire on her progress after the transfer. Clearly this is not the right way to manage a complicated situation.
Similar names: In our second example, there were two Mrs. Smith’s on an inpatient oncology unit, both receiving chemotherapy. One was to receive Cisplatin and the other was to receive Carboplatin. The nurse caring for Mrs. Smith #1 had to leave the unit suddenly and another nurse picked up her care. The second nurse inadvertently hung Cisplatin which was ordered for Mrs. Smith #2 on Mrs. Smith #1. Because the unit was short staffed, the nurse violated policy and did not have another nurse check the chemo before hanging the drug. The daughter of Mrs. Smith #1 came to visit, noticed the error and very angrily confronted the second nurse.
Known risk: And a third scenario, Mrs. Jones was an elderly patient who was a known fall risk and in fact attempted to climb out of her bed and fell and suffered a significant laceration to her skull. The nurse on duty happened to be coming into the room and witnessed the fall and the patient was quickly and appropriately taken care of.
While these scenarios are different, the concepts to manage these events effectively are similar. Here are some suggestions for managing these types of events to minimize the risk of a lawsuit.
#1 First and foremost, communicate all of the facts. In the case of the bile duct injury, the surgeon should have explained to the family not just that there was a bile duct injury but also outline a plan as to what would be done to care for the patient moving forward – and at some point, apologize that the patient has suffered a complication – simply indicating that he was sorry this happened – not to accept blame, but just an empathetic acknowledgement.
#2 Keep in contact with the patient and family. After the surgeon outlines a plan and consults with other specialists for appropriate care, he should maintain the relationship and stay involved in the patient’s care. If the physician does not stay involved, the patient and family may perceive this as abandonment and feel that his absence indicates that he clearly did something wrong or else he would not have disappeared.
#3 Demonstrate transparency by disclosing everything known about the event. In the case of the oncology medication error, fully disclose the facts of what happened. Explain any anticipated effects the error will have on the patient and what will be done to care for them. It’s OK to say “I am sorry this happened.” This error occurred – likely because of inappropriate handoff and inadequate staffing levels. In the case of the patient fall, notify the family of the fall, let them know the patient’s condition and what additional care, if any, is needed. They need to be assured that their family member is being taken care of, what precipitated the fall, and what precautions are in place to ensure this does not happen again.
#4 Determine and disclose the cause of the event. Because an event may be a result of a process error, a root-cause analysis should be performed. After the investigation of the incident, the patient should be informed of the outcome with an explanation of what measures are being put into place so it does not happen again. In the case of the chemo error, likely re-education of the nurses regarding policy for double checking medication administration procedures to verify correct patient, correct drug – while at the same time assessing staffing levels.
#5 Determine and communicate next steps. Follow up on what is being done as a result of the analysis of the event. What new policies and procedures or audit checks are being put into place to reduce the risk of adverse events? In the instance of the medication error – a violation of policies in place – be sure the nurse responsible has been counseled and that new processes are in place to flag similar patient names and similar drug names. In the case of the patient falling out of bed, reassure the family that more stringent precautions and strategies are being identified to prevent falls – such as hourly rounding – which has been shown to decrease falls in high-risk populations.
In summary, the key components of managing disclosure after an adverse event are transparency, thorough communication with the patient and family and analysis of the root cause that will inform next steps.