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By Jock Hoffman, CRICO

Related to: Communication, Diagnosis, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Is a patient who unexpectedly returns to the hospital, clinic, or doctor’s office shortly after concluding a stay or visit a red flag for a potential malpractice claim? Presumably, the caregivers felt that the patient’s health care needs had been understood, resolved, stabilized, or appropriately shifted to another care provider. Something must have gone wrong.

Physicians—frustrated by individuals who fail to comply with discharge instructions, follow-up visits, or medications—may want to blame the patient, who may be frustrated by the vagueness of what’s expected, or befuddled by complex instructions. When such bad feelings abound, physician-patient communication deteriorates further and the risk of malpractice allegations increases.

Recent studies of high readmission rates for Medicare beneficiaries attribute that trend to the patients’ lack of understanding about what to do after being discharged: specifically, follow-up visits with primary care providers and medication regimens. While the federal government looks to further study the problem, individual hospitals and physicians may want to begin working on some solutions. Better writing and communication of discharge instructions could reduce readmissions significantly. Improving the discharge process (or the communication at the end of an office visit) can also help align expectations, protect patients from preventable harm, and shield providers from avoidable lawsuits.

When a patient does return unexpectedly—or presents with a complaint unresolved by a recent encounter with a prior provider—a concerned physician or care team might consider these factors to identify why.

  • Is there any uncertainty about this patient’s most recent diagnosis?
  • Have the results of all ordered tests or imagings been received, reviewed, and communicated to the patient?
  • Are there any symptoms or complaints that might indicate a complication related to the most recent surgery, treatment, or therapy?
  • Did this patient make and attend any follow-up visits or referrals recommended at the end of the previous stay or visit?
  • Did this patient fill all of his or her prescriptions and is he or she taking them correctly?
  • Does the patient comprehend the care plan adequately enough to tell it to you?
  • Does this patient have adequate support at home to ensure compliance with his or her care plan?
  • Are other patients with similar histories or chronic diseases returning or being readmitted unexpectedly?

Diagnosing why returning patients are back can highlight recurring factors or chronic systems failures, helping you prioritize where to focus improvement efforts for all of your patients.

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June 1, 2009
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