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by Donna Knight, Princeton Insurance Healthcare Risk Consultant
Printable Version of this Article
While follow-up can be time-consuming, it is well worth the effort to prevent medical errors, unanticipated outcomes and potential liability. Communication breakdowns are a major contributing factor in patient safety and malpractice claims. A patient who misses appointments and suffers injury as a result may have cause for a lawsuit if he or she has evidence that the physician did not provide clear information or make reasonable efforts to make sure the patient understood and complied with advice, including follow-up appointments.
It is essential that a comprehensive, consistent communication process to support the continuum of care be in place so that your patients don’t “slip through the cracks.” This article addresses key communication elements before and during scheduled appointments, as well as after missed appointments, including tools for safe patient care.
Before
To help prevent missed appointments, practices have developed a telephone confirmation call to remind patients of their appointments and, when indicated, of the importance of the visit – especially for patients in active treatment. To cut down on the volume of missed appointments, some studies suggest that the confirmation call should be placed at least two days ahead of the scheduled appointment.
During
Standard of care, laws and ethics require that a physician-patient relationship be based on educated, informed/shared decision making. During office visits, patients should be educated on their disease process, care plan expectations, any perceived issues the patient has regarding non-adherence to plan of care, and consequences of not continuing with follow-up testing or treatment. Alternative plans, if appropriate, may be explored, agreed upon, and documented in the medical record. The discussion may be supplemented by educational material to be reviewed with the patient at the time of visits. The medical record documentation should reflect what information was shared with the patient, questions asked by the patient and responses given, and that the patient understood the proposed plan, benefits and the consequences of non-compliance.
Physician practices may consider utilizing a patient agreement or contract which is discussed with and signed by the patient. During subsequent visits, an informed refusal form should be signed if the patient will not comply with the plan. A generic practice policy statement, including patient responsibilities regarding compliance, follow-up and missed appointments, may also be implemented. A signed copy of the policy statement, such as is done with HIPAA privacy statements, may be maintained in the patient’s record.
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