HomeLearnNine Steps for Responding to Unanticipated Outcomes

Submitted Courtesy of Mary-Lynn Ryan
Risk Management
NORCAL Mutual Insurance Company and the NORCAL Group

One of the most difficult aspects of medical practice is disclosing an unanticipated adverse outcome, but it has to be done. The following nine steps provide a strategy for taking corrective action, maintaining the provider-patient relationship, and decreasing professional liability exposure. Depending on the circumstances, the order in which the following steps are completed may vary. In every instance, however, caring for the patient’s immediate needs should come first.

1. Take Care of the Patient

Obtain necessary consults, assign primary responsibility for providing care and make sure the patient/family has contact information for the primary provider. Because a patient may need extra accommodations to rebuild rapport, staff should also be aware of the situation and be involved in the process.

2. Preserve the Evidence

Preserve equipment and/or supplies that  may have contributed to an unanticipated outcome. Without evidence of properly (or improperly) operating equipment, a provider involved in a professional liability claim must depend on assumptions and memories— evidence that is more easily challenged than direct evidence of equipment status.

3. Document

Document in detail events that led to, took place during and followed an unanticipated outcome. This documentation can be instrumental in showing that the care at issue was appropriate, even though the outcome was not expected.

4. Complete Mandatory Reports

In a hospital setting, providers should contact the risk manager, relevant department managers and the peer review committee to determine which reports must be completed. When unsure of reporting requirements, providers can seek guidance from state medical associations, healthcare organizations and professional liability insurers.

5. Notify the Medical Liability Insurer
If an incident occurs that could lead to a lawsuit, providers should notify their medical liability insurer as soon as possible.

6. Disclose the Unanticipated Outcome

Sympathetically inform the patient or patient’s family about the adverse outcome as soon as appropriate. This can dispel anger, confusion and distrust. Questions should be answered honestly, without speculating, blaming or admitting liability. Feelings of not being told the whole story or of not being given the opportunity to ask questions and vent feelings can provoke a decision to seek the advice of an attorney.

7. Analyze the Unanticipated Outcome to Prevent Recurrence and Improve Future Outcomes

Perform a thorough analysis of the events that led to the outcome. The goals of an event analysis are to prevent such outcomes in the future and to improve their detection and the processes for responding to and reporting them. Based on the event analysis, a Corrective Action Plan (CAP) should be  developed and implemented.

8. Follow Through with Subsequent Disclosure Discussions

To meet the patient’s healthcare needs and  to address ongoing questions and concerns, schedule regular appointments or phone calls with the patient. This will help rebuild rapport and maintain communication.

9. Heal the Healthcare Team

An often-overlooked aspect of unanticipated outcomes and disclosure is the emotional toll on the individuals who provided care to the patient. Providers should recognize and honor the need to discuss feelings about an adverse outcome with family, friends and colleagues. Discussions of feelings should be distinguished from discussion of the facts of the patient’s care and any event analyses that are confidential.

Conclusion

Using these nine steps for responding to unanticipated outcomes can help preserve the physician-patient relationship, ensure that the patient’s medical needs are met, generate corrective action, and possibly prevent medical liability litigation.

Submitted Courtesy of Mary-Lynn Ryan
Risk Management
NORCAL Mutual Insurance Company and the NORCAL Group

This article was previously published in Managing Professional Risk, a quarterly feature of NORCAL Mutual Insurance Company and the NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL insureds. To learn more, please visitwww.norcalmutual.com/cme.

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