0071643192.pdf

LEGAL ISSUES

RISK MANAGEMENT

Physicians and hospitals attempt to “manage” risks, acknowledging the impossi-

bility or relative undesirability of perfect prevention. In health care, the fre-

quency of suit is low but the potential for loss is mind-numbingly huge. Research

has shown that only one factor correlates with outcome: Severity of injury.

We all want optimum quality care for all our patients. When we try to reduce

medical error or make other care-focused efforts, we follow the expected path

of the healer (and other fiduciary, learned-intermediary roles), placing the

best interest of those for whom we are responsible above our own. In so doing,

we also, we hope, reduce our chances of being sued.

The overlap between the quality assurance (QA) and risk management (RM) is

extensive. Some argue the two are coincidental. But the perspective and inten-

tion are undeniably different. Quality assurance protects the patient. Risk man-

agement protects the provider. Some examples of both:

RM ANDQA

■ Maintaining and enhancing knowledge and skills

■ Efforts to deliver best possible care

■ Maintaining safe setting

■ Records that communicate well

■ Patient and family relations

GIVEN THEUNSCIENTIFICBASIS FOR THEEXERCISE AND THEPITFALLSSURROUNDING THE

ATTEMPT, PHYSICIANSMAY B EJUSTIFIABLYDISCOURAGED, BUTWESTILLHAVE TOTRY.

THEFOCI OFRM INEM ARE

■ Care of boarded patients

■ Compliance, fraud, and abuse

■ Consent and refusal, capacity and holding patients

■ Contracts

■ Dealing with complaints and concerns

■ ED colleagues and staff performance, qualifications, and safety

■ EMS communications and relations

■ EMTALA

■ Follow-up after discharge

■ High-risk clinical situations

■ How patients and families perceive the EP and the ED

■ Insurance

■ Malpractice

■ Patient and family expectations

■ Preparedness

■ Records adequacy, accessibility, and confidentiality

■ Reporting, mandated and disallowed

■ The physical facility, supplies, and equipment

■ Transitions, at shift change and on admission, admitting orders

■ Triage, flow, delays

From various sources, the following clinical conditions appear most often

associated with malpractice claims:

■ Failure to diagnose/treat AMI

■ Missed fractures

■ Wound care, including missed vital structure injury and infections

RM QA

FIGURE 21.1. Risk

management and quality

assurance: overlapping

effect.

Quality assurance protects the

patient. Risk management

protects the provider.

Managing risk involves more

than medical malpractice.