What you don’t know about the threat to continuity of care can hurt you
LAPSES IN PATIENT CARE, including follow-up, can lead to dire consequences beyond those to patient well-being. Substantial malpractice settlements and verdicts have been paid as a result of “lost” diagnostic reports and physicians’ failure to review and follow up.
Patients who miss or cancel appointments risk undetected and untreated medical conditions, threatening continuity of care. If the patient later experiences an illness or injury, he or she may hold you responsible. The best way to prevent such lapses — and the corresponding malpractice allegations they create — is to develop written policies and procedures. The goal is to effectively track lab and diagnostic tests, as well as missed appointments and referrals.
LAB AND DIAGNOSTIC TESTS
Establish a tracking system that documents and follows patients referred for diagnostic imaging or laboratory testing. An effective system will verify the following:
• That the test is performed
• Results are reported to the office
• Physician reviews the results
• Physician communicates the results to the patient
• Results are properly acted upon
• Results are properly filed
It is important the physician or allied health professional (AHP) review, authenticate, and date all diagnostic test results as soon as they are available — before filing. When test results are abnormal, it is important to let the patient know both the results and the need for follow-up. If the patient does not follow through as advised, it is prudent to make — and document — repeated efforts to encourage the patient’s return.
CANCELLATIONS AND NO-SHOWS
Tracking missed or canceled appointments will help you improve patient care and reduce liability risk. When patients miss or cancel appointments, attempt to reschedule and document both the reason for cancellation and each of your efforts to reschedule.
We suggest the AHP review all missed or canceled appointments and discuss them with the physician to determine if follow-up is necessary. More aggressive follow-up may be necessary for patients with urgent conditions. Document all such efforts in the medical record.
CONSULTATIONS / REFERRALS
Plan to develop an effective system to identify and track patients who are scheduled for referrals and consultations. Document in the patient’s medical record all recommendations that a patient see a specialist for consultation or continued care. Include any letters or other communications between physicians in the medical record.
TYPES OF TRACKING SYSTEMS
Tracking systems do not have to be complex or expensive; they just have to work. Many medical practices use simple and inexpensive methods, such as logbooks. Others utilize tracking functions provided in their electronic medical records system. Whatever tracking method you choose, be sure to follow up on laboratory and diagnostic tests, cancellations, no-shows, and consultations.
article by LAURETTE SALZMAN, MBA, CPHRM, ProAssurance Risk Resource Advisor
The article is not intended to provide legal advice, and no attempt is made to suggest more or less appropriate medical conduct.