Medical Errors due to communication deficits occurring during shift change, on the weekends or when another doctor is covering for the attending physician are often the subject of litigation.
Medical errors are more likely to occur during a shift change or when one doctor signs off to another doctor. Weekends when staff is different or unavailable seems also to result in increased potential for medical errors to occur. Incomplete patient information, missing test results and poor communication among physicians and other healthcare providers result in potentially avoidable and catastrophic errors in healthcare. These can and often result in potential litigation.
Poor Communication during shift change
How often have you wondered what information has been communicated during shift change? How about the doctor that is covering for his partner or a colleague on a post-op patient? How much does the covering doctor truly know about the patient’s condition? How much time is spent making sure the critical information on the patient is communicated and how much of a duty is there for the handing off doctor to tell the covering doctor the details on the patient to make sure that the patient is kept safe? How much of the hospital chart should the covering doctor read to be prepared? All of these issues are serious issues and can lead to the patient receiving substandard care over the weekend or during shift change or when the attending doctor goes away on vacation and signs out to another doctor.
Recently I tried a medical malpractice case where the handing off doctor and the covering doctor pointed the finger at each other and blamed each other for missing critical signs of infection. While the two doctors didn’t make sure that their questions and answers on the patient’s condition were clear, critical information was not recognized and the patient’s condition worsened due to poor two-way communication.
According to a 2007 study in The Journal of the American Medical Association, direct communication between hospitals and primary care physicians is rare – happening only 3 to 20 percent of the time. The communication may only take place via consult notes or progress notes mailed or faxed to the primary care physician. An Archives of Internal Medicine study showed that 69.3 percent of primary care physicians reported sending patients’ histories to specialists all or most of the time, but only 34.8 percent of specialists said they routinely receive the information.
Conversely, 80.6 percent of specialists reported sending their results to the referring physician all or most of the time. But only 62.2 percent of primary care physicians reported receiving the information. Communication between doctors caring for a patient is critical and can oftentimes lead to oversights and medical errors. There have been many cases where a failure during the formal handoff of care from one doctor to another where communication errors have caused serious injury or death. For example, in one case an emergency room doctor was finishing his shift and wanted to get home. His patient, however, needed a specialized CT scan which could have been completed in the ER within fifteen minutes. Instead of doing the test, the doctor chose to hand the patient off to other doctors, but did so poorly and the CT never got done. As a result, the patient’s condition went undiagnosed for eight hours and he ended up dying. It was discovered that the hospital had no program in place for training its personnel on how to ensure proper handoffs. Sadly, this is far more common than it should be.
Successful Communication is the key!
To avoid communication failures with other medical professionals, physicians should deliver information face-to-face whenever possible. When information is sent, ask the receiver to confirm receipt. Without confirmation, the physician should follow up, rather than assume successful delivery. Standardized safety checklists can also help physicians avoid communication failures during patient hand-offs to another doctor. When a patient is in the ICU and his care is being assumed by another doctor over the weekend or at vacation time it is critical that the accepting or covering doctor review relevant information in the chart as well as obtain in a face to face hand off relevant information on the patient’s condition to continue the same level of care previously provided by the handing off doctor. We recently represented a client where the hand off was ineffective and the communication between the two doctors was faulty leading to grave consequences.
If you or a loved one has been injured due to the negligence of a medical professional, call or email us at Mishkind Kulwicki Law. We can help get your questions answered and help you understand what happened and whether the injury was due to a communication error and whether this error represents medical negligence.