Our responsibility with regards to non-compliant/no show patients

[mandrew]

Does anyone know from a legal standpoint what we are “supposed” to do regarding patients that have limb threatening conditions but fail to show for scheduled appointments or referrals to other specialists.
Is a documented phone call attempt sufficient, if so, how many? I have heard in the past that a letter sent certified mail is required. Does anyone have any experience with this? Is it different in PP vs hospital clinic setting? Thanks for your replies.

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[Feli]

Not sure what you are getting at here...
Limb threatening infections (if you're using Joseph book terms, or any other book I've read) don't miss appointments... because they are in the hospital, on IV abx, awaiting amp or I&D.

If you're talking about typical DFUs and minor burns and post ops and such just doing WCare and maybe taking PO abx, then yes... just document missed visits and that they were left a msg. You're not their mom or dad. Don't worry about it... plenty of other work. They're adults. The lord helps those who help themselves (I've never met that guy, but a lot of ppl seem to like him).

Simply communicate as best you can, then just teach staff to chart it when they no-show, re-schedule, do not fill abx, do not f/u with vasc, etc. Cert mail letter is only if you discharge them from the office (repeat no-shows, non-compliance detriment to their outcome, profanity to staff, various aggressive behavior, unpaid bills, etc). Do that and be done with it. It's podiatry, there are plenty of nearby associate mills that'll take them if you don't.

In reality, if you're owner, you can have low tolerance for pts that waste your time and appointments (diabetic/wound or otherwise).
If you're an employee (hospital or PP), you probably have to just see them anyway whenever they decide to come back of office, ER, WCC, whatever.

 

[Creflo]

A benefit of malpractice insurance is their risk management services. You can call them and ask for risk management, and discuss the particular patient, and they should give you specific guidance.

 

[Retrograde_Nail]

Does anyone know from a legal standpoint what we are “supposed” to do regarding patients that have limb threatening conditions but fail to show for scheduled appointments or referrals to other specialists.
Is a documented phone call attempt sufficient, if so, how many? I have heard in the past that a letter sent certified mail is required. Does anyone have any experience with this? Is it different in PP vs hospital clinic setting? Thanks for your replies.

I would document communication reports in their file saying you called them and left a message and document what you said in the message.

If they happen to pick up but refuse to come simply document everything you said to them.

This covers you.

 

[deleted1162946]

if you do a surgery on a limb salvage patient and later refer them to a wound care center are you responsible to still follow with the patient in addition to the wound care center?

I’ve had some very noncompliant patients that were initially wound care center patients and I’m consulted on them for the surgery. So if I send them back to them postop is that bad practice? I generally hope to at least manage most of the problems but some of these patients are difficult..

As long as you get them in the hands of someone else is that ok?

 

[Adam Smasher]

if you do a surgery on a limb salvage patient and later refer them to a wound care center are you responsible to still follow with the patient in addition to the wound care center?

I think it depends on goals of care and how you define success. Conventional wisdom seems to be that you have to do what it takes to epithelialize the wound. As we know, this is really hard to do 100% of the time in the most compliant of pts. If the standard of care is to heal the wound, it follows that the Podiatrist is negligent (ie liable) if they don't heal the wound.

I've argued with colleagues in my area that a more realistic definition of success is not to achieve wound closure but merely to achieve source control. Discuss with pt and document that the goal of surgery is to remove infected bone/abscess, you came here with a wound, you leave with a wound. Handle the high acuity issue (sepsis) inpatient and the low acuity issue (wound) outpatient. This way, if you want to flap/graft/surgically offload the pt, you still can, but you're not obligated, and you can do it on your own timetable. Also vascular and ortho do things this way all the time.