Malpractice risk at the transitions of care

Here's an interesting post on the topic at Kevin MD.

Various questions inevitably arise: “Did the primary doctor make sure that the hospitalist knows of the patient’s allergies? Did the hospitalist speak to the primary when the patient was admitted and discharged? Did the hospitalist convey the need for a follow-up computed tomographic scan in 3 months? Was there a delay in faxing the discharge summary? Does the patient know who he’s supposed to contact if complications arise?”

If something falls through the cracks and the patient sues over a bad outcome both the PCP and the hospitalist will be dragged in. The plaintiff attorney will encourage finger pointing between the two over who should have known what or who should have communicated what. Such finger pointing will only weaken the case for both defendants.

But things may get a little muddy if we don't have a standard for what constitutes adequate communication. The closest thing we have is this set of guidelines promulgated by the AAFP. Here are some points from the guidelines that may have impact on liability:

Before calling the hospitalist to admit a patient the ED physician should call the PCP. (Yeah, the plaintiff attorney will drag the ED doc in too). This puts the PCP in the loop and helps determine if admission is necessary.

The PCP should then communicate important clinical information to the attending hospitalist. The guidelines do not specify how this communication should take place.

During the course of hospitalization the hospitalist should communicate changes in clinical status to the PCP. Again, the guidelines do not specify the means of communication.

The hospitalist should communicate follow up needs to the PCP at the time of discharge. Concerning the means of this communication the guideline states: “This may be best accomplished by having the discharge summary dictated and faxed to the family physician.”

Family physicians, according to the guideline, are “encouraged” to maintain ongoing contact during hospitalization with the patient, the family and the hospitalist.