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Applying Quality Methodologies to Improve Healthcare Briefings on Patient Safety

Dear Jim:

I am interested in holding an event management program. The challenge is that I run various emergency departments in several states, and often times the so called “event” does not become apparent until after the patient has left the emergency department. Does this just not apply?

Kandace Keeper
Risk Manager
Champaign, IL

Dear Kandace:

I think you are interpreting the event management process a little too narrowly. Often one does not have the event available when dealing with an emergency department until after the patient encounter, for example, a discrepant X ray or a condition discovered on the second visit or a subsequent visit to a specialist. However, this does not negate the need for aggressive and proactive event management. Once you receive the information it is appropriate to do an investigation and reach out to the patient. Look at it (similar to the standard event management process) both as a potential liability issue in which you want to reduce the claim from being filed as well as the value of the claim if filed. Why did it occur? Were systems in place? Did the system fail to work under the particular circumstance? Use the event as a living laboratory. From a liability reduction point of view, you want to reach out to the family and provide them with the information that you have discovered and be there to respond to questions.

In the emergency department setting we have learned over the years that you do not have the advantage of creating an ongoing relationship, which is very important from the liability reduction point of view. However, you can develop a relationship when you reach out and communicate with the patient and/or family under the right circumstances. It is amazing to me how often I hear a patient or family rave about a particular provider (perhaps a specialist or an emergency department doctor) whom they have only seen for 20 or 30 minutes. In other words, sometimes it is the quality of the encounter and not the length of time.

Therefore, all of these proactive risk management principles – creating a five star practice, enhanced communication, aggressive and proactive event management apply to every health care setting.

Sincerely,
James W. Saxton, Esq.
Stevens& Lee
Lancaster, PA

P.S.
Have questions?
Send them to: jws@stevenslee.com