A recent report by CRICO Strategies, a data examination firm that is associated with Harvard Hospitals, surveyed approximately 23,000 cases of medical malpractice. Their findings confirmed that roughly 30% of these actions were caused by some form of a communication failure. When a patient uses multiple physicians, there is an inherent possibility that all or a portion of the information regarding the patient may not be communicated for some reason. Critical information may not properly flow between primary care doctors, specialists, emergency room medical staff, or in-patient hospitalist physicians. The result is injuries and potentially the large malpractice claims stemming from these preventable mistakes. The study listed that the total cost estimates relating to this problem as being nearly $1.7 billion annually.
Additional findings included that approximately 57% of cases resulted from communication errors between medical providers, while 55% were attributed to such failures involving the patient and their provider. The problem is not solely associated with patient inability to comprehend the communication, or mistakes in wording. The largest reasons stem from data that is not documented, is directed to the wrong party, not received, or otherwise ignored by the subsequent doctor. An example is when a primary care physician suspects the presence of a skin condition and makes a referral to a dermatologist. The patient sees the dermatologist who does some testing and orders medications. Shortly thereafter, the patient is unable to keep a follow-up appointment with the dermatologist. Meanwhile, the primary care physician has not received any findings, and is not aware of a prescribed medication by the other etc.
Rick Boothman, JD, who is employed by the University of Michigan Health System in risk compliance, highlighted two key concerns with potentially dangerous outcomes as being communication of data involving allergies and medications. Often these breakdowns will result in claims of malpractice. Another concern may be the culture within the medical facility. Along the chain of command, those on the lower end of the hierarchy may be hesitant to question potential problems out of fear of appearing to have a lack of knowledge. Many facilities have implemented ways to encourage better communications with protocols that trigger dialogue between nurses and doctors.
At the core of their study results, the largest problem occurs during the “handoffs” of a patient to another physician, particularly between the settings of private practice and hospitals. Many hospitals are now implementing interim or transition management systems to monitor this flow of communication. In fact, Medicare and insurance providers have the means of billing for this follow-up in most cases. The process of discharging patients from the hospital setting in a responsible manner is the key; however, as cost concerns escalate, and we move toward an ultra-efficient health care system, it is likely to be a continual challenge.