Are you spotting flags’ that indicate a potential medical error problem?
A well-educated patient is your best line of defense
There’s no doubt that one of the biggest medical issues in the news lately has been patient safety and the Institute of Medicine of the National Academy of Sciences report late last year spotlighting patient deaths and injuries as a result of medical errors.
Although the vast majority of fatal errors occur in a hospital setting and hospitals have received most of the attention so far, physician practices should start to look at patient safety in their offices, the experts advise.
"In general, medicine is very safe, but medicine also is very complex and not without risk," notes Nancy Dickey, MD. She is past chairwoman of the board of directors of the National Patient Safety Foundation (NPSF) in Chicago, one of several organizations joining to look for ways to reduce medical errors. "Any error that harms a patient is one error too many. While we may never achieve perfection, we must continue to strive for it."
"Most of the problems are not problems of individual performance. They are system failures. What practice administrators should focus on is how to make the systems work better," asserts William Jessee, MD, president and CEO of the Medical Group Management Association (MGMA) in Englewood, CO.
Watch for the signals
One way to begin your quest to improve patient safety is to think about the clinical-practice and patient-risk issues that keep you up at night, advises Sandra Berkowitz, RN, JD. She is senior vice president and managed care practice leader with Marsh Inc., a Philadelphia firm specializing in insurance and risk advisory services.
There are flags you can look for that can signal that your office systems need improvement. These include:
• missed appointments by patients who need important follow-up diagnostics;
• patients with a rapid increase in the number of office visits with more complaints;
• patients who call more than three times on the same issue;
• patients with bad test results who don’t follow up.
For instance, if a 15-year-old asthma patient has been in the office three times recently with peak flows that are less than marginal and ends up in the emergency room, that should be a red flag.
"If we have some measure to steer the practice to doing quality care, we’ll sleep better at night, be more satisfied that we have done a good job, and at the same time avert medical errors," says Fay Rozovsky, JD, MPH, senior vice president of Marsh Inc. and practice leader for Project MindShare in Richmond, VA.
Reduce errors by educating patients
Teaching patients how to be good patients goes a long way toward reducing medical errors, she points out.
One approach is to develop a brochure that introduces patients to your practice and explains how they can work to ensure they get the care they need. But you should supplement your written materials with personal communication, she adds. For instance, encourage your patients to be totally honest with the doctor or the nurse practitioner and not hide or emphasize symptoms. "It’s very hard to diagnose when you don’t know what the problem is."
If there is someone in the room with the patient, Rozovsky suggests asking that person to leave so everything said between patient and doctor is confidential.
Rozovsky suggests approaching any problems a patient may have with compliance upfront. Find out if the patient might have problems taking medication or can’t afford it, and deal with it deftly. If you think a patient needs a drug that can’t be taken with alcohol and the patient loves fine wines, you need to know it and make sure the patient is comfortable with taking the drug.
"The only way doctors can know is if they start questioning. They should be sure they understand how the patient feels and that the patient is comfortable with the treatment," Rozovsky says.
If you believe a patient needs a certain antibiotic but her plan won’t cover it, be upfront with that patient. Tell her how much it is likely to cost out of pocket and ask if she still wants that prescription. If she doesn’t, suggest alternatives but point out that it may take longer to treat the problem.
"You aren’t questioning the patients’ pocketbook, but you are telling them they have two tracks to take," Rozovsky says.
"For both plans and physicians, it is a matter of grappling with the idea of customers being empowered. Patients have choices to make. Do they want to spend $80 on medicine or go to a concert? Physicians have presumed they knew the answer to that," Berkowitz says.
What makes the patient satisfied is to feel better, to have a chronic illness managed well, to have someone they can talk to when they call, Rozovsky points out.
"If patients are unhappy, they feel dissatisfied and have bad outcomes, then you have all the right balls in line for a lawsuit," she adds.
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