Office Risk Assessment

Medical Protective developed an online office risk assessment tool to assist your clients in identifying issues that could adversely affect patient care in his/her practice. This tool utilizes an easy-to-use, check-box format to determine if recommended processes are in place, consistently used, and updated on a regular basis.

Responses to the assessment are confidential and will not be incorporated into any policy evaluation. Further, responses are not saved or available for reference once the session has been terminated.

The 'Communication' section of the assessment tool is shown below.

Section 6: Communication

Question Response
6.1

Each new patient receives a written introduction to the practice.

Correct! See Rationale Suggested Answer - Yes

A practice brochure should contain information on services available, hours of operation, access to emergency and after-hours care, phone numbers, referral processes, reporting of test results, returned phone calls, billing, and prescription refills. This information helps set the tone for the patient's relationship with the practice. It can also serve as a reference for the patient, facilitating patient cooperation and preventing misunderstanding. Phone numbers, fax, and email information (if utilized) should be provided.
6.2

The practice has a written confidentiality policy. All staff and contractors that have access to patient information re-sign the policy annually.

Correct! See Rationale Suggested Answer - Yes

Confidentiality is a prime concern in the physician office. Be very careful to avoid discussing patients or releasing confidential information without proper authorization.
6.3

Telephone triage, patient advice procedures, and urgent care guidelines have been approved by the physicians, and are regularly reviewed and updated.

Correct! See Rationale Suggested Answer - Yes

Many professional liability claims result from over-the-phone advice. When telephone advice follows an approved protocol, risk to the patient and practice is reduced.
6.4

The practice has a procedure and utilizes a standard approach to handoff communication, i.e. physician to physician, physician to nurse, etc.

Correct! See Rationale Suggested Answer - Yes

Standardized handoff communication reduces the potential for medical errors to occur.
6.5

Guidelines are in place to ensure patients receive return phone calls from physicians or designated staff. All patient calls and e-mails (both during and after hours) are documented in the medical record. Note: All components of this question must be answered 'yes' in order to score the question 'yes'.

Correct! See Rationale Suggested Answer - Yes

Patients should always receive return calls within a reasonable time. Additionally, patients should be told approximately what time their call will be returned. Documenting phone calls and e-mails from patients (including the information given to them to address their issue) will improve continuity of care and increase defensibility of potential claims. This can be done either by placing an on-call slip in the chart, or by writing a separate note in the chart or by printing/attaching the e-mail to the medical record. Periodic checks for compliance with the office telephone and e-mail policy are advisable.
6.6

A procedure requires the completion of a comprehensive medication reconciliation during each patient visit including review and documentation of each medication (prescribed by all providers as well as all OTC), dosage, frequency, route and indication.

Correct! See Rationale Suggested Answer - Yes

Medication Reconciliation is the process of reviewing a comprehensive list of patient's medications at each point in their care and then resolving any discrepancies that may exist, i.e.. duplicate medications, potential drug interactions and/or contraindications. All medications must be included in this process, including over the counter, herbs and supplements, and vitamins.
6.7

A procedure addresses continuity of care when patients are referred to specialists.

Correct! See Rationale Suggested Answer - Yes

Lack of communication or follow up between primary care physicians and specialists is a significant source of professional liability exposure.
6.8

A procedure addresses the termination of the professional relationship.

Correct! See Rationale Suggested Answer - Yes

When the physician makes the decision to discharge a patient from his/her practice, proper notification should be given. One method is to notify the patient by a certified letter (with a return receipt), with a copy to the medical record. The physician should offer to continue care until another physician has been selected. A reasonable time should be allowed for this to be accomplished (normally, 30 days).
6.9

All in-office procedures are in compliance with specialty society guidelines, and appropriate informed consent is obtained.

Correct! See Rationale Suggested Answer - Yes

Incorrect maintenance and use of equipment is a factor in many claims involving office procedures. It is also necessary to secure appropriate informed consent when doing office procedures.
6.10

The practice has a written emergency plan.

Correct! See Rationale Suggested Answer - Yes

The practice should have a written plan that addresses medical, environmental, and violence emergencies. It is important to regularly review the plan with the staff, and, if possible, periodically conduct drills.