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    Telephone triage can jeopardize patient safety, lead to litigation

    Staff must document all calls where medical advice, information is given to patient


    Case 2. A 44-year-old woman undergoes cryoablation for a small renal tumor. Three days after the procedure, the patient calls the office and speaks to an unlicensed medical assistant (MA) about pain radiating from her flank, hematuria, and changes in bowel habits. The MA suspects a UTI, asks the patient about typical symptoms associated with a UTI, and tells the patient to take ibuprofen. The MA does not talk with the physician, nurse practitioner, or physician assistant about this call as she did not perceive the symptoms to be serious.

    Read: Circumcision requiring revision surgery prompts lawsuit

    A few days later, the patient is admitted to the intensive care unit and ultimately expires, having sustained a bowel perforation from the cryoablation and becoming grossly septic. The urologist is sued for a failure to diagnose a bowel perforation, the symptoms of which he was never made aware.

    These two cases are demonstrative of how both licensed and unlicensed personnel in an office-based setting can jeopardize patient safety and increase the risk of litigation for a physician. Telephonic communication is unavoidable in medicine, which only heightens the importance of how it is handled. An American College of Physicians-American Society of Internal Medicine white paper found that one reason telephone triage presents such a risk is that the information is generally relayed by a layperson (the patient), and the interaction is based solely on verbal communication (bit.ly/Triagewhitepaper). A patient calling may not understand which of their symptoms are the most important to report, and a nurse or other licensed provider is not able to see or touch the patient, increasing the chances of an incorrect assessment and providing the wrong advice.

    Also see: Patient sues after stapler misfire leads to rectal tear

    So, how can physicians minimize risk of liability for telephone triage? There are lots of ideas out there, and each office setting should tailor their policy and protocols to the demographics of their patient population, the skill and expertise of their assistive staff, and with input from physicians practicing in that office.

    Next: Physician oversight imperative

    Brianne Goodwin, JD, RN
    Ms. Goodwin is manager of clinical risk and patient safety at Cambridge Health Alliance, Cambridge, MA.

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    • [email protected]
      I believe that one critical component of the process has not bee stressed in this article. While it is proper to document the positives and the negatives, there must be a way to let the physician know that there was a communication from the patient. If the physician has no reason to open the record of a patient, he may not see the note until the extreme situations described have already occurred. With a paper chart, a note on the front with a request to review the record is an easy way to have it reviewed. With EMR, a log should be kept so that the physician can review the notes and make a decision about how to proceed. If this were part of the protocol, these 2 poor outcomes might never have happened.