james p. capes, md, facep chief, emergency services emory university hospital midtown assistant...

JAMES P. CAPES, MD, FACEPCHIEF, EMERGENCY SERVICES

EMORY UNIVERSITY HOSPITAL MIDTOWNASSISTANT PROFESSOR

EMORY UNIVERSITY SCHOOL OF MEDICINE

How Risk Managers Can Best Partner with MD’s in their Hospital

(from an ED Perspective…)

Disclosures

I have no financial DisclosuresBUT… Willing to Listen!

Objectives

Review hospital- based complaint processUnderstand how MD’s can help and not helpUnderstand where complaints come fromReview best way to respond to complaintsDiscuss RCA’sMake sure everyone has same goalReview Special situations

Identify Your MD Contact

May be the Chief or his designeeThis MD should be:

familiar with the complaint process Familiar with the players and stakes Have some defined leadership position Be accessible and responsive Be reasonable and level-headed Helpful if familiar with medico-legal topics but can

learnWhat if my designated contact is none of

these things?

Complaints (a 2-way Street)

Come from several sources: Patients Families

Consent Special situations

Other MD’s Within the Specialty Outside the Specialty but within the Hospital Outside the Hospital

Issues with reviewing outside records Other Hospital Staff

Standard Communication

Try to always communicate with your MD contact first (and maybe only)

Come up with a standard email Include where the complaint came from The full name and identifier so contact can review the

record, including DOS The verbiage of the complaint A ‘need-by date’ (which is several days before the real

deadline). Include what is needed by the investigator If known, include the expectation of the Complainant.

Standard Communication

Have a standard follow-up regimenKnow that MD’s are busy and can misplace

important communication.If they miss the 2nd reminder, just call.

Physician Contacts

Need to know their coworkers.Usually not a good idea to just forward the

complaint to the treating provider Extremes Take personal Ignore

Give clear instructions for needed responsesEscalationI usually just send them open ended message

asking what happened.

Investigator to Complainant Contact

You should help them write a ‘standard letter’ that is customizable to the individual case.

Direct contact with the treating MD is not usually helpful or productive.

Make sure whomever is contacting is clear on what concessions (if any) are possible.

If a phone call is needed, usually a 3-way call including you is best.

MD’s have varied responses to legal threats- make sure to discuss before the call.

RCA’s

Very important to ensure get to the ‘root of the problem’

Ensure the culture is learning about event and not finger-pointing

Invite all partiesSet ground rules at the start of the meetingTry to stick to time limitsFollow-up with lessons learnedDiscuss with your legal representative- based

on state may be discoverable

Special Situations

Private groupsMultiple servicesProblem providersAPP’s

Review

Having quality MD input and review is vital to a risk manager’s job

Help your MD’s be successfulTry to keep the team focused on a common

goalRealize complaints are a part of healthcareTry to get to what prompted the complaintEnsure follow-up for those involved

Questions?