Two Minutes: What's the Risk?

Your ability to address risk effectively is crucial to a successful professional liability insurance program. ProAssurance’s Risk Management department provides innovative loss solutions through practice surveys, seminars, publications, and ongoing educational opportunities. Risk Management is committed to promoting patient safety, providing sound advice, and pledging Treated Fairly®. You deserve an insurance team dedicated to helping you solve problems while providing guidance to help you avoid risk, not just manage it. Access our “What’s the Risk?” video series on our playlist pages or on the Risk Management Youtube channel.

 

Medical Office

Service Animals

What happens when a patient shows up at your office or facility with a dog and claims that it is a service animal? Do you allow the animal in the waiting room with your other patients? Do you have the right to ask the patient why they require this animal? You soon find out that the dog is actually an emotional support animal. So now what? In this video, Tina Santos, Regional Manager, Risk Management, reviews the difference between service animals and emotional support animals.

Emergencies in the Medical Office Setting

Medical offices generally are not staffed and equipped like a hospital emergency department but patients and visitors may expect some type of response to a medical emergency. Kathy Dolan, Senior Risk Resource Advisor, explains the medical office’s role in a medical emergency and key considerations for a medical emergency plan. 

Parental Refusal of Vaccinations for Children

Many parents are refusing vaccinations for their children, and that issue is impacting pediatric practices—as well as other practices that treat pediatric patients. Because of this, many physicians are asking if they must allow unvaccinated children to be patients of the practice.

Senior Risk Resource Advisor Mallory Earley discusses considerations for pediatricians and family physicians when parents refuse vaccinations for their children.

 

Hand Washing

Hand hygiene is one of the most important ways to prevent the spread of infection.

In this two-minute video, Frederick Guenther, MD, FACOG addresses the importance of proper hand hygiene and why we need to get serious about this very basic (and low tech) preventative measure.

Customer Service

Poor customer service can lead to disgruntled patients who are more likely to pursue legal action. Risk Resource Advisor, Leslie Roberts, provides tips to help you reinforce positive patient relationships and improve customer service.

Nothing in this video is intended to provide legal or medical advice.

 

The Drug Seeking Patient

It can be difficult to determine whether a patient is seeking unnecessary medication or has legitimate pain management issues. In “The Drug Seeking Patient,” Dr. Greg Jackson provides tips to help you distinguish between the two.

 

 

 

 

Professionalism in Medical Examinations

Increasingly, news stories feature allegations of inappropriate conduct lodged against individuals in a variety of professional settings. One way for a physician to guard against similar claims is by implementing a chaperone policy for all sensitive examinations. In this video, William Ashley, Senior Risk Resource Advisor, explains how a chaperone policy not only respects a patient’s dignity, but also serves as a valuable tool in the defense of a professional liability claim.

   

After-Hours Calls

Providing patients access to after-hours care requires careful consideration. In this video, Senior Risk Resource Advisor Laurette Salzman discusses the importance of a consistent process for response to after-hours calls for improving both patient satisfaction and outcomes.

 

Charging for Medical Records

Requests for copies of patient charts and other records have become commonplace for most medical specialties. However, federal and state laws and regulations do not always provide a clear path to reimbursement for the costs and labor of producing these copies. In this video, Risk Resource Advisor Alex Ealy offers a basic primer in charging for medical records for medical practices and other healthcare entities.

 

Cybersecurity/Technology

Cybersecurity

Electronic health records contain valuable personal and financial data. A data breach can result in multiple, often expensive, challenges.

Learn how cyber-attacks can occur and access ideas for safeguarding private healthcare information.

 

     

Metadata

Metadata (which show actions on electronic devices) can be subpoenaed and presented as evidence in a malpractice trial. ProAssurance Assistant Vice President of Web and Digital Marketing, Steve Dapkus, explains how metadata are recorded and used in electronic medical records.

Nothing in this video is intended to provide legal or medical advice.

 

Patient Portals

Today’s patients appreciate the convenience of accessing their health records online through a secure patient portal. Ensuring the privacy and security of these electronic records is paramount. Director of Risk Resource, Brandy Boone, helps you understand important issues around patient portals.

Nothing in this video is intended to provide legal or medical advice.

 

Electronic Medical Record Documentation

Widespread adoption of electronic medical records brings unique liability risks for physicians and medical staff.

Senior Risk Resource Advisor, Stephen Shows, aids your awareness of some common risks and concerns related to electronic medical record documentation.

Texting: What could be the problem?

Communicating with fellow physicians and healthcare providers via text messaging carries both benefits and risks. Dr. Greg Jackson highlights related issues in “Texting: What could be the problem?”

 

 

 

 

Recording Conversations

In “Recording Conversations,” Dr. Greg Jackson shares risk issues that may arise when patients wish to record conversations with their physicians.

 

Telemedicine and Informed Consent

Although some states specifically regulate the process for informed consent in telemedicine, there are a number of general factors a physician should consider when obtaining that consent, such as the nature of the patient’s condition, confidentiality, and the technological capabilities necessary. In this video, Senior Risk Resource Advisor Mallory Earley discusses the process for obtaining informed consent when practicing telemedicine.

 

ProAssurance Value Adds

Risks of Social Media

Social media is a critical communication and promotional tool for most businesses and healthcare providers are no exception. However, there are many potential risks that healthcare professionals should be aware of when utilizing social media.

      

       

The Legal Defense Endorsement

Many ProAssurance policies, regardless of the state in which they are issued, contain a version of the Legal Defense Endorsement. This endorsement provides legal expense and audit expense coverage for what the endorsement defines as “covered investigations” and “covered audits.”

ProAssurance Policy Holder Services Representative Robin Beasley explains the basics of the Legal Defense Endorsement.

   

On-Site Risk Assessments

Have you ever thought about the potential risks your practice faces? One of our value-added services is On-site Risk Assessments—where a highly-trained Risk Resource Advisor comes to your practice and guides you through assessing your potential risk.

Leslie Roberts, Director, Patient Safety of ProAssurance’s Risk Resource Department discusses the process of having an on-site assessment performed and the benefits this process offers.

Physician Contingency Planning/Closing a Practice/Filling in

Closing a Practice

There may be a number of reasons why a physician may be closing his or her practice. Whatever the reason, there are certain considerations for ensuring a smooth transition for patients. In this video, Mallory Earley, Southeast Regional Risk Manager, discusses some of those considerations. Learn about notifying patients and taking steps to safeguard patient records after the close of the practice.

Contingency Planning for Solo Practitioners

Compliance officer, business manager, human resource director, marketing chief: these are but a few of the roles assumed by the solo practitioner in addition to that of physician. What happens to the solo practitioner’s patients and practice when she is unexpectedly incapacitated? In this video, Risk Resource Advisor William Ashley explains how some advance planning can help to prevent significant professional liability risk if a solo practitioner is suddenly unable to practice.

Independent Medical Examinations

Physicians are often asked by third parties to perform Independent Medical Examinations, or IMEs, on patients. While these examinations are typically limited in scope and often do not give rise to the traditional physician/patient relationship, they can still present a liability risk to the physician. In this video, Risk Resource Advisor Alex Ealy discusses a number of items that a physician should consider to mitigate professional liability risks when performing IMEs. 

Documentation

Documentation

Medical records document patient care and are a critical reference tool for the physician and healthcare staff. Sadly, we also see medical records used as a legal document against the physician—challenging the healthcare that was provided to the patient.

To help deter threats of litigation, ProAssurance Risk Resource Director Mark Hakim offers ten useful tips for mindful medical record documentation. It only takes two minutes for you to benefit from this important information.

 

Document the Care You Provided As You Were Trained

What can healthcare professionals do to mitigate risk when a patient refuses to follow a treatment regimen or advice?

Dr. Greg Jackson discusses how careful documentation can help you reduce liability risk associated with noncompliant patients.

Nothing in this video is intended to provide legal or medical advice.

 

 

EHRs & Chart Reviews

During litigation, electronic health records (EHRs) can profoundly impact how allegations of malpractice are resolved.

Randall A. Juip, JD, describes the importance of a periodic quality review of charts to ensure consistent and standardized methods of documenting patient care by healthcare professionals.

 

 

Using Scribes

Scribes enter patient information in the EHR, freeing the physician to focus exclusively on patient care. A scribe’s role must be clearly defined and communicated—with documented job descriptions and set policies and procedures—to optimize their use and minimize challenges.

Mark Hakim, Director, Strategic Partnerships, ProAssurance Risk Resource Department, describes the risks and benefits associated with using scribes in your practice or organization.

Tracking/Follow-Up

Failure to follow up with a patient—especially when it involves abnormal test results—can lead to medical professional liability allegations against physicians and others.

Hayes V. Whiteside, MD, ProAssurance Chief Medical Officer and Senior Vice-President, explains how adequate follow-up could have made a difference in a recent claim.

Nothing in this video is intended to provide legal or medical advice.

Medical Staff

Advance Directives

Advance directives are legal documents created by a patient prior to healthcare treatment to record preferences regarding their care They are one of a number of areas where patients’ rights and healthcare operations intersect. In this video, Nichole Pieters discusses advance directives and the potential risk exposures posed by an organization’s failure to properly follow the documented wishes of a patient. 

Workarounds

Often, physicians and staff must accomplish a patient task but cannot use the ideal method because the current work process has a flaw. Workarounds, or deviations from the standard process, are informal temporary workflows to accomplish a task that is perceived as dysfunctional. These alternative care deliveries may appear to function adequately, until an adverse event occurs or a patient experiences a near-miss. In this video, Wendy Alderman, Senior Risk Management Consultant, discusses risks when workarounds are utilized in the delivery of healthcare.

Three Most Important Issues for Practice Administrators

Statistics show the question of whether a physician will be sued is “when” not “if.” 

Randall A. Juip, JD offers three suggestions to aid practice administrators in insulating physicians, their practice, and employees against the risk of malpractice litigation.

 

 

Fall Prevention

Falls in healthcare facilities often result in patient injuries that lead to professional liability litigation for the healthcare provider. While it may not be possible to completely eliminate the risk of falls in your facility, you can implement strategies to improve your fall with injury rate. In this video, Risk Resource Advisor Brad Byrne discusses risk mitigation strategies to help reduce the rate of falls in your facility.

Staff Competencies

The process of obtaining and documenting clinical staff competencies has evolved from a once per year checklist into an ongoing process of education and evaluation. Senior Risk Resource Advisor Joanne Simmons provides some recommendations for healthcare organizations to consider in this area.

 

   

 

Universal Protocol Time Outs

The wrong patient. The wrong surgery. The wrong site. These are concerns that healthcare organizations are still facing. Having an efficient and consistent time-out process is important for every procedure. Dr. Hayes Whiteside, Chief Medical Officer and Senior Vice-President for ProAssurance, addresses the need to prioritize this moment to help reduce your risk. Stop, take a time-out, and make patient safety a priority for your organization.

   

Behavioral Health in Emergency Departments

Millions of Americans present to emergency departments with behavioral health complaints each year. In this video, we offer strategies that could improve outcomes for patients in psychiatric crisis and reduce the burden on hospital emergency departments.

 

Handoff Communication

In this video, Lisa Hallman, a Senior Risk Resource Advisor for ProAssurance, provides several considerations for helping ensure that handoff communication is clear, consistent and effective. 

 

 

 

   

Incident Reporting

Senior Risk Resource Advisor Sharron Haroutunian discusses the importance of incident reporting for both managing liability risks and improving processes within a healthcare organization.

   

   

   

Violence in Healthcare

In “Violence in Healthcare,” Dr. Greg Jackson cites the alarming rise in violence against healthcare workers and provides tips to help improve safety.

 

 

 

 

 

Hospital Setting

Safety Huddles

The purpose of safety huddles is to not only provide a trusting forum for your staff to alert team members of unsafe situations, but to support colleagues who may be overwhelmed and need assistance. In this video, Senior Risk Resource Advisor Brad Byrne discusses the importance of using safety huddles to improve patient safety and expedite event investigation and resolution.

Alert Fatigue

Many electronic monitoring systems use some type of audio alert, like a beep or buzz, to notify medical personnel when a device registers an abnormal bodily function or other condition requiring prompt attention. Studies indicate that as use of electronic systems have become more prevalent in medicine, the number of audio alarms or alerts has also increased dramatically. In this video, Senior Risk Resource Advisor Eric Cleckler provides points to consider when addressing alerts and potential alert fatigue.

   

Chain of Command

Chain of command policies are not just for guiding staff through the proper channels to help resolve grievances or other differences. They can also have a positive influence on patient outcomes by encouraging communication and resolving issues. In this video, Senior Risk Resource Advisor Tina Reynolds describes the value of following the chain of command.

 

 

 

Identifying Retained Surgical Objects

Surgeons and operating room staff ask radiologists to assist in confirming or ruling out a retained surgical object by radiograph. In “Identifying Retained Surgical Objects,” Dr. Bob Stroud explains how his group created a glossary and digital file of commonly used surgical objects to help radiologists and surgeons at their hospital reduce the risk of retained surgical objects. 

   

   

Mental Illness in the Emergency Department

Emergency Departments (EDs) are vital to the delivery of healthcare in emergency situations, but some medical emergencies are more challenging than others. Senior Risk Resource Advisor Christine Lynch-Tock discusses the unique challenges in caring for patients with mental health or substance abuse disorders in the ED.

 

 

 

Claims/Litigation

Responding to Subpoenas

As a healthcare provider, you may receive a subpoena requesting the release of a patient's medical records. Understanding the legal obligations and procedures for responding to such subpoenas is an essential part of the modern practice of medicine.

     

   

Direct Liability

In medical liability lawsuits, hospitals, medical groups, and other healthcare entities can be held directly liable for their own negligence in addition to any vicariously liability for their employee’s negligence. This 2 Minute video explains how proper documentation can help mitigate direct liability risk.

    

Litigation & Support Training

In today’s litigious society, it is important for physicians to understand their rights and responsibilities when faced with a lawsuit and be prepared to manage the burdens that often accompany litigation. This 2 Minute video explains how litigation and support training can be a valuable resource for physicians to help them prepare for and respond to legal actions that may arise from their medical practice.

     

HIPAA BAA

Complying with HIPAA mandates to safeguard protected health information (PHI) is essential for medical practices, and challenging when PHI is handled by third-party vendors subject to HIPAA compliance. This video offers strategies that can help.

   

   

 

CURES Act

The 21st Century Cures Act, enacted in 2016, established new federal regulations on a variety of healthcare concerns including funding, research, access to new and experimental drugs, telehealth, and interoperability of health information technology and introduces a new phrase to the healthcare community: information blocking.

 

   

Jury Expectations and Test Results

Jurors often think that if a physician orders a test, they require the information and care about the results. 

If a physician later testifies that following up on the test result was unnecessary, this can cause a disconnect in the juror’s mind. 

Randall A. Juip, JD, describes how test follow-up helps demonstrate thoughtful physician care in the context of litigation.

   

When to Report Claims

Physicians are sometimes unclear as to when they should report a claim or incident to their medical professional liability carrier.

ProAssurance Senior Claims Specialist, Marta Garrett, provides information on when to pick up the phone and make a call to receive important guidance.

Nothing in this video is intended to provide legal or medical advice.

 

Screening Exam Follow-Up

Routine but important screening exams are recommended by physicians every day. The majority of these exams will have normal results not indicative of a serious condition. However, all results require routine follow-up.

Chief Medical Officer and ProAssurance Senior Vice President Dr. Hayes Whiteside discusses the devastating consequences of failure to follow up on results of routine exams.

 

 

 

Physicians Under Pressure: Helpful Strategies to Reduce Liability

Setting clear plans, goals, and expectations from your first patient encounter is critical when caring for patients. 

Dr. Dallas discusses several important tools to help develop trusting relationships, potentially reducing liability.

 

 

   

Physician Wellness/Burnout

Don’t Abandon Medical Judgment to Please a Patient

Today’s patients are less likely to blindly heed a physician’s recommendations for care. In this two-minute video, Stephen Dallas, MD, MA discusses ways to encourage patients to follow doctors’ recommendations.

 

 

 

 

Terminating the Physician-Patient Relationship

The decision to end a patient relationship can be daunting. In this two-minute video, ProAssurance Risk Resource Advisor Aaron Hamming provides key considerations for deciding to end a patient relationship. In addition, you’ll learn how best practices can reduce related liability.

The Power of Medical Errors: A Physician’s Perspective

Author of "When We Do Harm: A Doctor Confronts Medical Error," Dr. Danielle Ofri talks about the emotional impact of medical errors on caregivers and how to approach them among the care team.

 

         

Doctor-Patient Communications

Unexpected Outcomes

While healthcare providers do not intend to cause harm, unexpected outcomes can occur. However, a regrettable result does not mean that there was negligence. Prompt and honest communication can have an impact on whether the unanticipated outcome will lead to a lawsuit.

   


   

The Non-Compliant Patient

In “The Non-Compliant Patient,” Dr. Greg Jackson shares suggestions on how to manage patients who repeatedly cancel appointments or ignore your medical advice.

 

 

 

 

Patient Complaints

A successful medical practice strives for patient satisfaction, but patients may still complain about care received or some other aspect of a medical practice. In this video, Joanne Simmons, Senior Risk Resource Advisor for ProAssurance, offers suggestions for how a practice might generally respond to a patient complaint. With careful attention to the issue, good communication, and consideration for possible resolutions, you may reduce your risk exposure and possibly find patient satisfaction again.

 

 

 

Physicians Under Pressure: Non-Compliant Patients

Patient non-compliance presents a variety of challenges for physicians, including potentially negative effects on patient outcomes, as well as the relationship between physician and patient.

Stephen Dallas, MD, MA describes some of these scenarios. If the physician and patient cannot come to an agreement, it may be necessary to terminate the relationship.

 

 

 

   

 

Physicians Under Pressure: Friendships and Distractions

Patients may desire a social relationship beyond the boundaries of professionalism with their physician. However, minimizing personal distractions may result in a more effective professional physician-patient relationship.

Besides a brief greeting, Stephen Dallas, MD, MA, advises you keep relationships in the exam room professional and leave social interactions outside.

 

 

 

 

Informed Consent

Informed consent must be treated as an educational process which advises patients and protects physicians.

Chief Medical Officer and ProAssurance Senior Vice President Dr. Hayes Whiteside discusses effective and thorough methods for meeting informed consent requirements.

 

 

 

The Limited English Proficient Patient

In the “The Limited English Proficient Patient,” Dr. Greg Jackson provides an overview of communication risks and responsibilities regarding patients who speak little or no English (when that is your language).

He also shares tips to help you mitigate risks and improve communication.