Health care risk management assignment week 5

Chapter 11: Risk Management in Selected High-Risk Hospital Depts

High Risk Depts. in Hospitals

• All clinical depts. in hospitals have potential for risk, but some are greater than others:

– Emergency Room

– Obstetrics and Neonatology

– Surgery and Anesthesia

– Diagnostic Imaging

• Treat highly vulnerable patients in often chaotic settings where the results of errors can be catastrophic and costly

Emergency Medicine

• Which Definition? – AMA – any condition clinically determined to require

immediate medical care

– Federal Legislation – condition manifested by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to an individual’s health, serious impairment to bodily functions or serious dysfunction of any body organ or part

– Clinicians –view emergencies as life-threatening situations

• The mere existence of an ER implies a duty to treat any patient who arrives

Emergency Medicine Issues

• Emergency Medical Treatment and Active

Labor Act (EMTALA)

• Pre-hospital services

• Dept Capabilities and Staffing

• Triage Process

Emergency Medicine Issues

• Medical Records Documentation and

Consent

• Support Services

• Departures, Discharges and Transfers

• Risk Management

Obstetrics and Neonatology

• Lawsuits in this category are usually the

most expensive

– Advanced technology has improved survival

rates for infants but led to increased risks for

facilities

• Ethical Dilemmas

• Standards and Guidelines

• Levels of Care

– Level 1 – least intensive and designed to treat low-risk mothers and babies

– Level 2 – must be able to manage high-risk mothers, high-risk fetuses and small, sick neonates

– Level 3 – must be able to monitor and maintain critical functions of mothers and neonates the nurse to patient ratio is more intensive as well

Obstetrics and Neonatology

Obstetrics and Neonatology

• Prenatal and Perinatal Care

• Intrapartum Period

• Delivery

• Neonatal Resuscitation and Management

• Maternal Exam Post Delivery

• Family Attendance Issues

Obstetrics and Neonatology

• Medical Record Documentation

• Neonatal Services

• Infant Transport

• Infant Abduction

Surgery and Anesthesia

• Surgery and Anesthesia claims are usually

co-dependent

• Increased number of surgeries performed

in outpatient or ambulatory settings with

decrease in number of claims

• Paid malpractice claims are higher in the

outpatient setting

Surgery and Anesthesia

• Negligence and Malpractice

• Surgical Services Staff

• Preoperative Assessment and Treatment

• Intraoperative Risks

• Postoperative Recovery

• Documentation

Surgery and Anesthesia

• Intraoperative Risks

– Sedation and Anesthesia

– Wrong Site, Wrong Procedure, Wrong Person

– Implants

– Retained Foreign Bodies

– Patient Burns and Pressure Injuries

– Surgical Fires

Diagnostic Imaging

• Creating images of the human body utilizing various methods:

– X-rays

– Computed tomography (CT)

– Interventional radiography

– Ultrasound

– Magnetic resonance imagine (MRI)

– Positron emission tomography

Diagnostic Imaging

• Malpractice allegations

– Failure to diagnose

– Misdiagnosis

– Wrong diagnosis

• Errors

– Scanning -- Satisfaction of search

– Recognition -- Visual perception

– Decision making -- Influential perception

Diagnostic Imaging

Radiation exposure: GOAL - as low as reasonably achievable

– Decrease time of exposure

– Increase distance of the patient and staff from radiation source

– Use proper shielding

Summary

• These high-risk areas in the hospital should

be carefully reviewed for appropriate policies

and procedures as well as compliance with

them

• Communication and good customer service

with patients is key in these high-risk areas

• Documentation is imperative in all areas but

especially in high-risk departments which

tend to have a higher likelihood of litigation