4. Growing Use of Team Care May Open New Risks
ACOs, patient-centered medical homes, and hospital systems are increasingly using teams of healthcare professionals to provide care to a patient, and this raises a few possible liability dangers.
One danger is that sometimes it may seem as though no one is in charge. "The old model of a single doctor participating heavily at each step of treatment is giving way to expanded-care teams," says Kevin Bingham, a casualty actuary at Deloitte Consulting based in Hartford, Connecticut. "The doctor/patient relationship has been diluted. No one doctor is answerable."
Even when a doctor is not involved in an error, membership on the team may create a liability, says DiGiacinto, the New York defense attorney. A plaintiff's attorney could use the legal concept of vicarious liability to hold that physician liable. " The notion is you're only as good as your weakest link. If another physician is not good at documenting the case, then you may be liable," he says.
Furthermore, team members sometimes pass off responsibility because they have conflicting views on what care is needed. A 2014 study[8] on team care found that "with complex patients treated by different physicians, it sometimes happens that a physician does not feel the responsibility to act because he has a different view of the treatment than the physician in charge."
One area of concern is poor handoffs, says Thomas R. McLean, MD, an attorney who is CEO of American Medical Litigation Support Services in Shawnee, Kansas. McLean says that when members of a team are defendants in a malpractice case, the can be a lot of "finger-pointing" about what was said and what was not said.
Also, patients who are confronted by many different people taking care of them may not have a bond with anyone. "There is a danger of losing the personal connection, which is how most med-mal claims start," Bingham says.
How big of a risk are these new concerns? Bingham thinks many teams have already addressed such concerns as poor communication. This involves taking a few simple precautions, such as designating nurses or other professionals to be the go-to person for the patient. Reaching out to patients after appointments and hospitalizations, this person can avert mistakes that arise when communication among team members breaks down.
A 2012 article[9] published in JAMA shows how to deal with the legal challenges of team care. Above all, teams should develop clear lines of accountability for patient care. "Team members should have clear roles, mutual trust, effective communication and shared goals," the article states.
5. Smartphones Distract Doctors
The rise of smartphones in the past decade has created a new malpractice risk—the distracted doctor. When doctors and other medical staff are on their smartphones, "they are no longer in the room," says Peter J. Papadakos, MD, an anesthesiologist at the University of Rochester Medical Center, who has been pioneering safer use of the devices.
Dr Papadakos says anesthesiologists in particular are prey to smartphone use. "They sit in the operating room and there's not much going on, so they start to look at their smartphone," he says. An anesthesiologist was named in 2014 malpractice case involving a patient death during heart surgery in 2011. According to depositions[10] in the case obtained by a Dallas newspaper, the surgeon in the case accused the anesthesiologist of looking at a cellphone or tablet and failing to notice the patient's low blood-oxygen levels for 15-20 minutes. The outcome of the case has not been reported.
A 2012 study[11] demonstrated the dangers of smartphone disruptions for surgeons. Residents were asked to perform simulated surgery and were then interrupted by a cellphone call or someone asking about complications with a previous patient. When they returned to the simulated surgery, more than 4 out of 10 made serious errors.
Smartphone distractions also affect primary care physicians. "A patient might be telling you something about their health, and your smartphone goes off, Dr Papadakos says. John Halamka, MD, a Massachusetts healthcare IT guru, reported a case[12] involving a resident who failed to complete an order to stop a heart drug for a patient because she was distracted by a text message inviting her to a party. The patient underwent open-heart surgery owing to the mistake, but survived.
In 2012, the ECRI Institute listed[13] cell phone distraction as one of the top 10 technology risks to patient safety. But a 2011 study[14] showed that medical staff tend to downplay the problem. A survey of perfusionists found that although almost all of them said they'd never been distracted while using cell phones at work, one third said they have seen colleagues distracted by them.
Despite the dangers, Dr Papadakossays there are still very few regulations on use of smartphones, and many hospitals don't have policies on them. "All this technology came down so fast that we weren't able to figure out what the rules should be," he says. The iPhone®, which greatly expanded the uses of cell phones, was introduced just 8 years ago.
What can you do to mitigate the dangers of smartphones? Dr Papadakos provides several recommendations:
Establish a policy. The policy adopted by the University of Rochester Medical Center in 2012 requires staff to silence their cell phones when working with patients and forbids using phones for personal matters at work.
Provide dedicated devices for work use. Dedicated devices with limited access mean that patients can still use the technology, but only for work.
Identify and help addicted users. Dr Papadakos thinks there is such a thing as smartphone addiction. He says a simple test can identify it, and high-scorers can get confidential help.
Tell the patient what you're doing. When you're using a smartphone or tablet in front of patients, make sure to inform them about what you're doing. "They might think you're booking an airline ticket," Dr Papadakos says. Suspicions that you're not interested in them can destroy the bond of trust and motivate lawsuits.
