Two patients, two adverse outcomes, and one likely malpractice litigation

The two short cases below highlight the risks of poor communications and documentation. Systems to process and capture patient telephone calls exist, and can be easily incorporated into your practice to minimize your risk exposure and to improve patient care. Please read the cases and visit the attached link that provides guidelines for an effective telephone call management system.

Case 1. Your patient was admitted, diagnosed with gastritis. On the day of discharge the patient's wife called to report that the patient was experiencing a burning sensation in his chest. Your partner correctly advised the wife that this symptom was to be expected and that you would follow up. Two days later the patient called your office and told another partner that he was experiencing intense burning in his chest. This partner prescribed a pain medication. The next day, the patient's wife called to report that she found her husband unresponsive. The day after the patient's death, the patient's wife called you expressing great anger. An attorney has requested your office records and phone logs.

You now learn that you were not advised of the phone calls to your office, although your partner told the wife that you would call back. Because the calls were not documented in a log or in the patient's record your second partner did not know about the first complaint call when he prescribed medication. Your office is responding to the attorney's request.

Case 2. Another of your patients underwent one day surgery and was discharged home under his sister's care. At 6:00 the following morning, the patient's sister called your answering service. You called the patient's sister back promptly and she reported that the patient had an episode of nausea, vomiting and cold sweats during the night after he took Dilaudid. The sister reported that the patient had a similar reaction with a narcotic in the past. You advised her to use a different medication, to see his surgeon at 9:00 am as scheduled, and to go to the Emergency Department or call 911 if the symptoms recurred. When you got off the phone with the sister, you documented the time of the phone call, the sum and substance of your conversation, as well as your assessment and advice, all on your "on call" note card, to be placed in the patient's chart. During office hours that morning, you were notified that the patient was found unresponsive at home and was brought to the ED, and expired.

The family accepted your expression of sympathy.

Each of the cases involves the death of a patient, but the first likely will end up in litigation. The classic ingredients are present-an angry family member who believes she was not heard and the failure to properly process and document phone calls. Of course the wife took notes and recorded the information of what was said, to whom, what time, and so on. Your record contains none of that information. Your ability to defend yourself, and argue that the patient's death may have been inevitable is compromised because you are unable to refute the family's version of events.

Communication failures can form the core of malpractice actions. Juries are sympathetic to plaintiffs who allege that physicians did not promptly return phone calls, that complaints were not dealt with effectively or that one physician did not know what was told to another. You can't prevent every adverse outcome but you can protect against becoming a defendant in a case involving communication failures by implementing an effective process to capture and document all clinically significant telephone calls coming in to your practice, both during and after office hours.

Practice Guideline for Telephone Call Capture