Richard B Stuart DSW, ABPP, George Birchfield MD, Timothy E Little MD, Susan Wetstone MD, James McDermott MD
Risk managers and ethicists monitor adherence to codes of conduct in the delivery of medical services and proactively participate with providers to create protocols that minimize the moral, ethical, and legal risks inherent in many commonly used medical protocols. “Code/no code” medical orders work well for patients at the extremes who always or never want to undergo a procedure, but they create troubling uncertainties for others by preventing them from expressly requesting procedures under some circumstances but not others. Obeying binary orders such as DNAR (Do Not Attempt Resuscitation) can allow deaths that a patient might want to delay or can expose patients to prolonged suffering they wish to avoid. These risks can be reduced by: (1) fully explaining the nature of proposed interventions and their possible beneficial and adverse effects in varying circumstances; and (2) replacing the traditional dichotomy with a continuum of options from always, through conditionally sometime, to never orders adapted to a range of situations and preferences. The Conditional Medical Orders (CMO) form summarizes patients’ preferences regarding resuscitation, ventilation, and artificial hydration and nutrition (ANH) is an efficient way to increases the chance that patients will undergo only the treatments they want.
{"title":"Use of conditional medical orders to minimize moral, ethical, and legal risk in critical care","authors":"Richard B Stuart DSW, ABPP, George Birchfield MD, Timothy E Little MD, Susan Wetstone MD, James McDermott MD","doi":"10.1002/jhrm.21487","DOIUrl":"10.1002/jhrm.21487","url":null,"abstract":"<p>Risk managers and ethicists monitor adherence to codes of conduct in the delivery of medical services and proactively participate with providers to create protocols that minimize the moral, ethical, and legal risks inherent in many commonly used medical protocols. “Code/no code” medical orders work well for patients at the extremes who always or never want to undergo a procedure, but they create troubling uncertainties for others by preventing them from expressly requesting procedures under some circumstances but not others. Obeying binary orders such as DNAR (Do Not Attempt Resuscitation) can allow deaths that a patient might want to delay or can expose patients to prolonged suffering they wish to avoid. These risks can be reduced by: (1) fully explaining the nature of proposed interventions and their possible beneficial and adverse effects in varying circumstances; and (2) replacing the traditional dichotomy with a continuum of options from always, through conditionally sometime, to never orders adapted to a range of situations and preferences. The Conditional Medical Orders (CMO) form summarizes patients’ preferences regarding resuscitation, ventilation, and artificial hydration and nutrition (ANH) is an efficient way to increases the chance that patients will undergo only the treatments they want.</p>","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 3","pages":"14-23"},"PeriodicalIF":0.0,"publicationDate":"2021-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/09/JHRM-41-14.PMC9543663.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sindhu Krishnan MD, Kimberly K. Wheeler DNP, RN, CNOR, Marc Philip Pimentel MD, MPH, CPPS, Joshua C. Vacanti MD, Richard D. Urman MD, MBA
Adverse event reporting systems are important tools for identifying areas of risk and opportunities for education and improvement. Our goal was to examine the nature of perioperative incident reports related to care coordination that were filed by staff at an academic tertiary care center.
In this retrospective data review, perioperative safety reports between 2015 and 2020 were analyzed. Information examined included the type of staff who initiated the report, location of the incident, type of incident and the severity level of event, including patient harm.
Out of the 7827 reports evaluated, 61.2% of reports were filed by nurses, and 5.6% by physicians. We investigated one particular category called “coordination of care” and found the specific event most commonly reported was insufficient handoff (15.0%–26.9%), with severity level reported primarily being no to minor harm reaching the patient. However, communication failures were judged to be one of leading causes of inadvertent harm.
It is imperative for hospital incident reporting systems to collect data on issues related to communication failures and to design interventions with the help of frontline staff to provide high quality, safe care to patients and to remain compliant with regulatory requirements and hospital policies.
{"title":"The nature of reported safety events related to care coordination in the operating room setting in a tertiary academic center","authors":"Sindhu Krishnan MD, Kimberly K. Wheeler DNP, RN, CNOR, Marc Philip Pimentel MD, MPH, CPPS, Joshua C. Vacanti MD, Richard D. Urman MD, MBA","doi":"10.1002/jhrm.21491","DOIUrl":"10.1002/jhrm.21491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Adverse event reporting systems are important tools for identifying areas of risk and opportunities for education and improvement. Our goal was to examine the nature of perioperative incident reports related to care coordination that were filed by staff at an academic tertiary care center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p>In this retrospective data review, perioperative safety reports between 2015 and 2020 were analyzed. Information examined included the type of staff who initiated the report, location of the incident, type of incident and the severity level of event, including patient harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p>Out of the 7827 reports evaluated, 61.2% of reports were filed by nurses, and 5.6% by physicians. We investigated one particular category called “coordination of care” and found the specific event most commonly reported was insufficient handoff (15.0%–26.9%), with severity level reported primarily being no to minor harm reaching the patient. However, communication failures were judged to be one of leading causes of inadvertent harm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <p>It is imperative for hospital incident reporting systems to collect data on issues related to communication failures and to design interventions with the help of frontline staff to provide high quality, safe care to patients and to remain compliant with regulatory requirements and hospital policies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 3","pages":"25-29"},"PeriodicalIF":0.0,"publicationDate":"2021-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhrm.21491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39570705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information - About ASHRM","authors":"","doi":"10.1002/jhrm.21420","DOIUrl":"https://doi.org/10.1002/jhrm.21420","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 2","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhrm.21420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137946821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information - Editorial Review Board","authors":"","doi":"10.1002/jhrm.21422","DOIUrl":"https://doi.org/10.1002/jhrm.21422","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 2","pages":"64"},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhrm.21422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137946822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A little help from my friends","authors":"Sue Boisvert BSN MHSA, CPPS, CPHRM, DFASHRM","doi":"10.1002/jhrm.21488","DOIUrl":"10.1002/jhrm.21488","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 2","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39537261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Issue Information - Board of Directors","authors":"","doi":"10.1002/jhrm.21421","DOIUrl":"https://doi.org/10.1002/jhrm.21421","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 2","pages":"63"},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhrm.21421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137946820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John C. West JD, MHA, DFASHRM, CPHRM, Christopher J. Allman JD, DFASHRM, CPHRM
{"title":"Case Law Update","authors":"John C. West JD, MHA, DFASHRM, CPHRM, Christopher J. Allman JD, DFASHRM, CPHRM","doi":"10.1002/jhrm.21490","DOIUrl":"10.1002/jhrm.21490","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 3","pages":"41-48"},"PeriodicalIF":0.0,"publicationDate":"2021-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jhrm.21490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39535813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"2021 in review and resiliency","authors":"Margaret Garrett CPHRM, DFASHRM, BSN, MED, JD","doi":"10.1002/jhrm.21489","DOIUrl":"10.1002/jhrm.21489","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 2","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2021-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39508253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John C. West JD, MHA, DFASHRM, CPHRM, Christopher J. Allman JD, CPHRM, DFASHRM
{"title":"Case Law Update","authors":"John C. West JD, MHA, DFASHRM, CPHRM, Christopher J. Allman JD, CPHRM, DFASHRM","doi":"10.1002/jhrm.21484","DOIUrl":"10.1002/jhrm.21484","url":null,"abstract":"","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 2","pages":"56-62"},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39444685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert Allen MD, Angela G. Cai MD, MBA, Peter Tepler MD, Ian S. deSouza MD
Physicians believe that malpractice concerns result in unnecessary testing, and many emergency physicians state that avoiding malpractice is a contributing factor to ordering medically unnecessary tests. Unfortunately, defensive medicine does not come without possible harm to patients who may be subject to non-beneficial, downstream testing, procedures, and hospitalizations. We submit a novel statistic, “NUTS” or “Number of Unnecessary Tests to avoid one Suit. ” We calculated a NUTS of 4737 for troponin testing in ED patients with suspected myocardial infarction, meaning a clinician will need to order 4737 medically unnecessary troponin tests to avoid one missed myocardial infarction lawsuit. The NUTS framework offers us an evidence-based lens to examine defensive medicine less superstitiously and more based on currently available data.
{"title":"The “NUTS” statistic: Applying an EBM disease model to defensive medicine","authors":"Robert Allen MD, Angela G. Cai MD, MBA, Peter Tepler MD, Ian S. deSouza MD","doi":"10.1002/jhrm.21486","DOIUrl":"10.1002/jhrm.21486","url":null,"abstract":"<p>Physicians believe that malpractice concerns result in unnecessary testing, and many emergency physicians state that avoiding malpractice is a contributing factor to ordering medically unnecessary tests. Unfortunately, defensive medicine does not come without possible harm to patients who may be subject to non-beneficial, downstream testing, procedures, and hospitalizations. We submit a novel statistic, “NUTS” or “Number of Unnecessary Tests to avoid one Suit. ” We calculated a NUTS of 4737 for troponin testing in ED patients with suspected myocardial infarction, meaning a clinician will need to order 4737 medically unnecessary troponin tests to avoid one missed myocardial infarction lawsuit. The NUTS framework offers us an evidence-based lens to examine defensive medicine less superstitiously and more based on currently available data.</p>","PeriodicalId":39819,"journal":{"name":"Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management","volume":"41 3","pages":"9-12"},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/jhrm.21486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39422467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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