JAMES P. CAPES, MD, FACEP CHIEF, EMERGENCY SERVICES EMORY UNIVERSITY HOSPITAL MIDTOWN ASSISTANT PROFESSOR EMORY UNIVERSITY SCHOOL OF MEDICINE How Risk Managers Can Best Partner with MD’s in their Hospital (from an ED Perspective…)

Disclosures I have no financial Disclosures BUT… Willing to Listen!

Objectives Review hospital- based complaint process Understand how MD’s can help and not help Understand where complaints come from Review best way to respond to complaints Discuss RCA’s Make sure everyone has same goal Review Special situations

Identify Your MD Contact May be the Chief or his designee This MD should be:  familiar with the complaint process  Familiar with the players and stakes  Have some defined leadership position  Be accessible and responsive  Be reasonable and level-headed  Helpful if familiar with medico-legal topics but can learn What if my designated contact is none of these things?

Complaints (a 2-way Street) Come from several sources:  Patients  Families  Consent  Special situations  Other MD’s  Within the Specialty  Outside the Specialty but within the Hospital  Outside the Hospital Issues with reviewing outside records  Other Hospital Staff

Standard Communication Try to always communicate with your MD contact first (and maybe only) Come up with a standard  Include where the complaint came from  The full name and identifier so contact can review the record, including DOS  The verbiage of the complaint  A ‘need-by date’ (which is several days before the real deadline).  Include what is needed by the investigator  If known, include the expectation of the Complainant.

Standard Communication Have a standard follow-up regimen Know that MD’s are busy and can misplace important communication. If they miss the 2 nd reminder, just call.

Physician Contacts Need to know their coworkers. Usually not a good idea to just forward the complaint to the treating provider  Extremes  Take personal  Ignore Give clear instructions for needed responses Escalation I usually just send them open ended message asking what happened.

Investigator to Complainant Contact You should help them write a ‘standard letter’ that is customizable to the individual case. Direct contact with the treating MD is not usually helpful or productive. Make sure whomever is contacting is clear on what concessions (if any) are possible. If a phone call is needed, usually a 3-way call including you is best. MD’s have varied responses to legal threats- make sure to discuss before the call.

RCA’s Very important to ensure get to the ‘root of the problem’ Ensure the culture is learning about event and not finger-pointing Invite all parties Set ground rules at the start of the meeting Try to stick to time limits Follow-up with lessons learned Discuss with your legal representative- based on state may be discoverable

Special Situations Private groups Multiple services Problem providers APP’s

Review Having quality MD input and review is vital to a risk manager’s job Help your MD’s be successful Try to keep the team focused on a common goal Realize complaints are a part of healthcare Try to get to what prompted the complaint Ensure follow-up for those involved

Questions?