The Case for Collaboration
By Laurie C. Drill-Mellum
As the healthcare industry relies more on advanced practice providers, how can we increase our effectiveness while minimizing risk?
As chief medical officer at MMIC, I am immersed in the world of medical malpractice and an increasing volume of patients. It is through that lens that I view what is occurring in our industry.
I note, for example, an increasing shortage of primary care providers. In the emergency medicine world, the shortage of physicians and the quest to provide more cost-effective, high quality care have led to more advanced practice providers (APPs) working in emergency departments (EDs), as well as the development of “medical homes” that enlist multi-disciplinary teams to deliver care. I see how these stressors play out in increased physician burnout, lack of engagement, strained communication, unspoken conflict, and short-changed patients … in a phrase: increased risk.
Even as we accustom ourselves to the unfamiliarity of this changing landscape, we also need to think in new ways about risk, as more players become involved in providing care, and new relationships are forged among them. It is increasingly apparent that collaboration among members of these newly constituted health care teams will be key to realizing the promise and benefits of these new models, while minimizing their associated risks.
What are the risks?
We are seeing more claims against APPs but there are more APPs providing care, so we would expect that. Whether the increase is disproportionate is harder to determine, primarily because many claims against APPs are dropped owing to the deeper pockets imputed to the supervising MDs, hospitals or clinics insuring the APP.
It is more revealing to look at the causes of loss specified in those claims.
In reviewing malpractice data from emergency medicine, where physician assistants or nurse practitioners have been named in claims or lawsuits, one thing quickly becomes evident: APPs who provide urgent and emergency medical care have many of the same “underlying causes of loss” as physicians do.
We found that, for physicians and APPs alike, the three most frequent causes of loss specified in claims are:
● Delayed or missed diagnoses – Accounting for about 50 percent of paid expenses for the investigation, defense and indemnity (or payment) to the plaintiff, the majority of these cases ended in a permanent injury or death.
● Treatment-related allegations – Accounting for about 30 percent of closed claims, allegations include failure to initiate the appropriate treatment, improper or negligent performance of a treatment, and improper or delayed medical management in a variety of scenarios.
● Medication-prescribing allegations – Including failure to recognize known contraindications to the use of certain drugs in certain clinical circumstances, dangerous adverse drug interactions, wrong medication, wrong dose, and mismanagement of patients on long-term anticoagulation therapy.
We encourage providers to do several things that research has shown reduces risks in the above areas, including:
● Developing better systems for tracking abnormal lab data
● Ensuring appropriate follow-up or consultation
● Developing clearer evidence-based practice guidelines
● Focusing on improving communication with patients and among members of the health care team
This last point is more important than many healthcare practitioners realize; miscommunication is an underlying cause of loss in 80 percent of malpractice cases. Not only does working effectively together reduce the risk of lawsuits … it can lead to increased patient safety and better outcomes. And MMIC can help with that.
Laurie C. Drill-Mellum, MD, MPh, is Vice President and Chief Medical Officer at MMIC.
This article originally appeared in the Winter 2014 issue of Brink, a quarterly risk solutions magazine published by MMIC. Published with permission.