Anesthesiology – Managing your cases to reduce the risk of a law suit.

Anesthesiology today is much less risky than it used to be:  25 years ago, 15 years ago, 10 years ago,  10  months ago; it seems that the work of the County medical societies. Private Anesthesia Groups, the national society (ASA), local and regional hospitals, the work is all paying off. Now, by national actuarial statistics, the average Anesthesiologist has a 6 % chance of being sued every year.

In an article that The Doctors’ Company published years ago, written and researched by our own Anne Lofsky, M.D., our beloved Board Member, she points out some of the best practices in two of our remarkably performing, claims free, and large Anesthesiology Groups.

The Anesthesiologist Establishes a relationship with the surgical patient prior to the procedure:

The night before the operation, the Anesthesiologist telephones the patient to review the procedure, to check in on their precondition, review contra indications, risks and generally discusses the goals of the procedure.

At this time, any problems that might be present the night before, but not yet visible;  the Anesthesiologists are encouraged to review carefully the chart, and, then based upon the information in the chart, to ask probing and specific questions to the patient.

During this home interview, the patient will, or might reveal important information about the preoperative condition, anxiety or past reactions to surgeries.  Some of this information would not be discovered without the preoperative phone call.

The Anesthesiologists in these high performing groups also follow up with a post-operative phone call, it stands to reason that in addition to just checking in on the medicine, the condition of the patient and the variable reaction to the trauma of surgery, the post-operative phone call establishes a strong rapport and builds a great relationship with the patient.

Working well with others in the Hospital

Both of the Anesthesiology Groups that were studied (just two quality groups) work well with the OR staff, the pre op nurses and the family, patient and Post Op Rehab and recovery staff.  The high performing and functional Anesthesia Group understand that we cannot pick em.

Just as in most successful medical groups, communication, internally, laterally, horizontally, externally, between other medical groups, facilities, communication is the key to success. 

American Academy on Communication in Healthcare:

Communication is such a common theme in our Risk Management sessions: I thought it worth underscoring by way of citing a national organization working hard to improve healthcare overall.  The American Academy on Communication in Healthcare put out a simple statement to emphasize the need to continue to work on this aspect of healthcare.  The “research is very clear that communication and relationships issues are critical to patient care and have multiple influences on outcomes”  Communication and relationship have been demonstrated to have an impact on patients’ experience of care.  The patient’s experience in general improves everything about the recovery process. The implementation of the regimen, clinical outcomes, patient safety success by the team, even the sensitivity to the patients’ needs were perceived to be better if there is strong communication between the provider and the patient.

These successful Anesthesia Groups understand that the way to provide good medicine is to work on formal communication. If the physicians and the patients and the staff are in synch, then there is a measurable reduction in medical malpractice risk.

 These Anesthesia Groups are always learning:

Learning is a lifetime activity, and this postulate is never more true than in these successful Anesthesia Groups.  The successful groups make it a part of their routine, part of the normal course of things to participate in quality improvement activities.  The Anesthesiology groups can even earn premium reductions (5 % premium credits) by participating in quality improvement risk management seminars or webinars.  

Physicians participate

The doctors in these groups participate in quality improvement such as hospital and facility risk management committees, best practices analysis and review, and medical records tutorials.  If the physicians help to select the medical staff, and they work on the hospital committees together, then in a moment of crisis, they are more likely to have faith in their decision and to trust their intuition and judgment.  When physicians trust the momentary decisions that often have to be made in crisis situations, the patients outcomes are more favorable, the families are more likely to get behind the treatment because they can see the unified belief in the path and plan for the family member.

Physicians also participate in the informed consent process.  The forms used, the scope of the discussion, the language used and to whom are all situations, issues that need to be regularly evaluated and discussed,  there is that theme again, “discussed’; most of these groups are involved from top to bottom in participating in discussions about informed consent, outcome management, pre op discovery and education and post op comprehensive planning and recovery management.

When there is an unavoidable adverse outcome:

These Anesthesia Groups practice immediately getting in touch with the patients to directly and sensitively express the truth; there is the entire apology movement in medicine that can be used as a resource and guideline for properly communicating adverse outcomes. Washington University Physicians puts out a helpful guideline that expresses the same basic important tenet,

Communicate immediately without saying “I caused this”.

  • Claim liability without criticizing the medical care of others
  • Do not make excuses, just straightforward, regretful of the outcome,
  • Focus on the outcome and what we can do from here, with sympathy
  • Do not alter any personal notes or, of course, not the record in any remote fashion
  • Do not state or imply that anything you speculate may have caused the reaction, or why you believe the adverse outcome occurred unless it is clear and unequivocal.
  • When an error occurs, all members of the group are informed, they share the information and collectively, with protocol, decorum, professionalism and powerful collaboration work to solve the problem so that everyone learns, and the harm is lessened in any way possible.

 

 

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