Health care law and legislation

SCOOBYR

9781284538588_SLID_CH08.pptx

Home >Business & Finance homework help >Management homework help >Health care law and legislation

Medical Staff Organization and Physician Liability

Chapter 8

LEARNING OBJECTIVES

Describe medical staff organization and committee structure.

Describe the credentialing and privileging process.

Describe common medical errors involving patient assessment, diagnosis, treatment, discharge, and follow-up care.

Discuss how the physician–patient relationship can be improved.

Medical Staff Committees Executive Committee

Recommends medical staff structure.

Develops a process for reviewing credentials.

Recommends appointments to the medical staff.

Develops processes for delineating clinical privileges.

Performance improvement activities.

Conducts peer review.

Review & act on reports of medical staff departmental chairpersons & medical staff committees.

Bylaws Committee

Organization of the medical staff is described in its bylaws, rules, & regulations.

Bylaws must be approved by the governing body.

Bylaws must be kept current & the governing body must approve recommended changes.

Bylaws describe various membership categories of the medical staff (e.g., active, courtesy, consultative).

Blood & Transfusion Committee

Develops blood usage p & p

Monitors transfusion services

Monitors

indications for transfusions

blood ordering practices

each transfusion episode

transfusion reactions

Credentials Committee

Oversees application process for medical staff applicants, requests for clinical privileges, & reappointments to the medical staff.

Makes its recommendations to the medical executive committee.

Infection Control Committee

The infection control committee is generally responsible for the development of policies & procedures for investigating, controlling, & preventing infections.

Medical Records Committee Develops Policies & Procedures

Release, security, & storage

Determining the format of medical records

Monitoring records for accuracy

Completeness, legibility, & timely completion & clinical pertinence

Ensures records reflect condition & progress of the patient, including results of all tests & therapy given & makes recommendations for disciplinary action as necessary.

Pharmacy & Therapeutics Committee

Policies & procedures (e.g., selection, procurement, distribution, handling, use, & safe administration of drugs, biologicals, & diagnostic testing material).

Oversees development & maintenance of formulary.

Evaluates & approves protocols for the use of investigational or experimental drugs.

Pharmacy & Therapeutics Committee Oversees

tracking of medication errors

adverse drug reactions

management, control, effective & safe use of medications through monitoring & evaluation

monitoring of problem-prone, high-risk, & high-volume medications

Tissue Committee

Surgical case reviews including

justification & indications for surgical procedures

Utilization Review Committee – I

Monitors & evaluates utilization issues such as medical necessity and appropriateness of admission & continued stay, as well as delay in the provision of diagnostic, therapeutic, & supportive services.

Ensures each patient is treated at appropriate level of care.

Utilization Review Committee – II

Objectives of the committee include:

transfer of patients requiring alternate levels of care

promotion of efficient & effective use of resources

adherence to quality utilization standards of third-party payers

maintenance of high-quality, cost-effective care

identification of opportunities for improvement

MEDICAL DIRECTOR

Serves as a liaison between medical staff & organization's governing body & management.

Medical Staff Privileges – Screening Process

Application

Medial Staff Bylaws

Physical & Mental Status

Consent for Release of Information

Certificate of Insurance

State Licensure

National Practitioner Data Bank

References

Medical Staff Privileges – II

Delineation of Clinical Privileges

Governing Body Reaponsibility

Appeal Process

Delineation of clinical privileges

Reappointments

Medical Staff Privileges – III

Limitations on Requested Privileges

Failure to Screen for Competency

Physician Supervision and Monitoring

Practicing Outside Field Of Competence

Misrepresentation of Credentials

Disruptive Physicians

Negative impact on an organization's staff and ultimately affect the quality of patient care.

Physician's inability to work with other members org staff can be sufficient grounds to deny staff privileges

Disruptive Physicians Rage in the O.R.

Experts say that doctor’s bad behavior is not merely unpleasant; it also has a corrosive effect on morale And poses a significant threat to patient safety.

—Sandra G. Boodman, The Washington Post, March 5, 2013

PATIENT ASSESSMENTS

Process of determining a patient’s disease.

Accurate diagnosis involves the process of identifying a patient’s illness.

Patient assessments & reassessments

Diagnostic test results (e.g., imaging and laboratory studies) are some of the tools of medicine that assists providers in diagnosing the possible causes of a patient’s symptoms & medical problems.

Common Medical Errors Patient Assessments

Failure to Conduct a Timely Assessment

Failure to Conduct Thorough Assessment

Inadequate Assessment of Unconscious Patient

DIAGNOSIS

Medical Diagnosis

Process of determining a patient’s disease.

Making an accurate diagnosis involves the process of identifying a patient’s illness.

Patient assessments, reassessments, & diagnostic test results.

Most frequently cited injury.

Common Medical Errors Diagnosis

Failure to Order Tests

Failure to Order Indicated Diagnostic Tests

Failure to Order Appropriate Imaging Studies

Failure to Make a Timely Diagnosis

Failure to Read Post Operative Report

Common Medical Errors Diagnosis - II

Delay in Conveying Imaging Results

Mitral Valve Malfunction

Failure to Diagnose Breast Cancer

Patient’s X-Rays Misread

Patient Wrongfully Diagnosed with AIDS

Common Medical Errors Diagnosis - III

Patient Allergy Communication Breakdown

Failure to Order Diagnostic Tests

Failure to Review Lab Tests

Failure to Consult with Radiologist

Common Medical Errors Diagnosis - IV

Failure to Obtain Second Opinion

Failure to Refer to a Specialist

Failure to Follow-up on Test Results

TREATMENT

Attempt to restore the patient to health following a diagnosis.

Application of various remedies and medical techniques, including the use of medications for the purpose of treating an illness or trauma.

Choice of Treatment: Two Schools of Thought

Common Medical Errors Treatment

Delay in Treatment

Selecting the Wrong Treatment

Failure to Treat Known Condition

Medication Errors

Wrong Dosage

Abuse in Prescribing

Excessive Dosage

Common Medical Errors Treatment - II

Failure to Advise the Patient of Treatment Alternatives

Wrong Patient Wrong Surgery

Wrong Site Surgery

Wrong Pocedure

Improper Performance of a Procedure

Common Medical Errors Treatment - III

Foreign Objects Left in Patients

Anesthesia: Failure to Maintain Adequate Airway

Surgery: Improper Positioning of Arm

Preventing Surgical Mishaps

Discharge and Follow-up Care

Failure to Override Physician’s Discharge Order

Failure to Follow-Up

Infections

Leading cause of injury and unnecessary deaths.

Failure to Follow Hand Hygiene Guidelines

Poor Infection-Control Technique

Infections a Recognized

DENTISTRY

Lack of Consent

Practicing Outside the Scope of Practice

Failure to Refer

Dental Hygienist Administers Nitrous Oxide

DENTISTRY - II

Failure to Prescribe Antibiotics

Failure to Follow Sterile Technique

Drill Bit Left in Tooth

Negligent Injection

OBSTETRICS

C-Section Delay Causes Injury

Failure to Perform C-Section

Failure to Attend Delivery

Fetus Decapitated

Untimely C-Section

PSYCHIATRY

Commitment

Commitment by a Spouse

Commitment by a Parent

Continuation of Commitment

Untimely Discharge

Duty to Warn

ABANDONMENT

Elements Necessary to Recover Damages

Medical care unreasonably discontinued

Discontinuance against patient’s will

Failure to assure follow-up care for patient

Foresight - failure could result in patient injury

Actual harm was suffered by patient

Physician-Patient Relationship - I

Personalize treatment

Conduct thorough assessment

Develop comprehensive treatment plan

Take time to get to know your patient

Request consultations when needed

Closely Monitor your patient’s progress

Maintain complete, legible, & accurate records

Physician-Patient Relationship - II

Do not guarantee treatment outcomes

Provide coverage when off-duty

Do not overextend your practice

Limit telephone orders

Do not become careless because you know the patient

Seek advice of counsel should you suspect a legal action

REVIEW QUESTIONS – I

Discuss importance of delineating clinical privileges.

Why is it important that the governing body approve the appointment and reappointment of physicians to the medical staff?

What, if any, sanctions should be imposed upon an on-call physician who fails to respond to such call when requested? Discuss your answer.

Describe what options a hospital has in disciplining a disruptive physician. What effect can a physician’s behavior have on patient care?

REVIEW QUESTIONS – II

5. When two physicians have opposing views as to care, what course of action should the patient's attending physician follow?

6. Describe malpractice risks for radiologists and attending physicians.

7. Is a poor outcome always an indication of a negligent act? Explain.

8. When is a physician considered to have abandoned his or her patient?