Thursday, March 20, 2008

Closed Malpractice Claims related to Delayed Diagnosis

Here is an article from the Annals of Internal Medicine that systematically reviewed the causes of closed malpractice claims related to delayed diagnosis & delayed care. Of note, failure to have a follow-up plan was attributed as the breakdown in 45% of the 181 cases (and most of the cases were cancer related). Failure to follow-through is significantly improved with EMR and electronic treatment planning but it goes back to the missed appointment problem. A patient books a follow-up to discuss a problem then misses the appointment. What happens to the chart? Does it sit on a shelf and wait for the patient to call back or does the office actively pursue contracting the patient. Does the work flow plan to contract the patient have an error rate (an error being that you forgot to contact the patient) of six sigma (3.4 per million) or is it much lower.

Sometime take a look back in the schedule for patients that no-showed on follow-ups and see what the office did to contract them again. Is there a group of charts somewhere going back years with forgotten & missed patients?

Another interest point was that handoff's were considered a contributing factor in 20% of cases. Multiple handoffs means multiple (and compounding) six sigma rates. The more steps there are the higher the sigma value must be of each step to maintain the same overall error rate. Thanks to Running a Hospital for the link to the article.

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