Practice of Medicine

article

The Importance of Early Reporting and Early Resolution

By: Bill Kanich, MD, JD

Executive Summary 

When a bad outcome or sentinel event occurs, it is imperative to reach out to your malpractice insurance provider immediately. Your insurance carrier can help you take early action to preserve the patient-provider relationship. Often an apology or explanation to a patient or their family can help a physician avoid a lawsuit. 

Recommended Actions  

  • Reach out to your insurance carrier as soon as a bad outcome or sentinel event occurs. 
  • Consider utilizing programs to assist patient-provider relationships such as the Preserve Program® offered by MagMutual. 
  • Ask your insurance provider how to engage in an honest and open conversation with patients or their families once a bad outcome has occurred. 

Deciding when to report a bad outcome is a difficult decision for physicians and healthcare providers. On the one hand, providers are obligated to report outcomes that could lead to claims to their malpractice insurance provider; on the other, reporting every unanticipated outcome could quickly become burdensome. 

All states have different requirements for reporting certain incidents. In addition, The Joint Commission adopted a formal Sentinel Event Policy in 1996. Sentinel events are patient safety events that result in death, permanent harm or severe temporary harm, or require an intervention to sustain life. 

Calling your insurance provider immediately is critical after a bad outcome occurs. It’s important to begin that discussion with your insurance carrier right away and take action within the first few days, or even hours, after an injury has occurred.1 

Your medical liability provider may also have programs to assist with the patient-provider relationship once an adverse outcome has occurred. The Preserve Program is MagMutual’s early intervention, patient-centered approach for addressing unexpected medical outcomes and preserving the patient-physician relationship. 

In some cases, from a patient experience perspective, the patient/family is expecting an explanation and/or an apology. That’s something that your insurance carrier can help with, especially for early resolution. Take advantage of the Preserve Program before the patient/family gets frustrated and goes to an attorney. 

Honest and open communication and a commitment to correction are at the core of patients’ expectations following an unexpected medical outcome. MagMutual has learned that early and honest interaction with patients who experience unexpected medical outcomes or complications relieves much of the anger and frustration that can result in claims and suits. 

For example, physicians in South Carolina have mandatory event reporting requirements to the South Carolina Department of Health and Environmental Control (SCDHEC). Hospitals and providers must report the following incidents to the department: 

  • Incidents resulting in death or serious injury
  • Suicides 
  • Wrong-site surgery 
  • Medication errors resulting in death or serious injury 
  • Major fractures or head injuries resulting from falls or other events 
  • Patient death or serious injury resulting from being in a restraint 
  • Criminal events and assaults 
  • Transfusion errors 
  • Neonatal injuries 
  • Maternal deaths or injuries 
  • Elopement event 
  • Anesthesia-related events resulting in death or serious injury 
  • Ventilator errors resulting in death or serious injury 
  • Infant abductions 

Lessons Learned  

  • Consider offering training to providers to improve how they communicate with patients after a bad outcome. 
  • Ensure that providers know the quickest way to contact their insurance provider and who they should speak to regarding bad outcomes or sentinel events. 
  • Follow state department of health reporting requirements for reporting unexpected incidents or sentinel events. 

Potential Damages 

Providers who remain indifferent to the impact that unexpected outcomes have on patients are more likely to face legal action. As a broad category of medical errors, litigation following a sentinel event is relatively frequent, but can become extremely costly to defend or compensate patients for injuries they suffered. 

Quiz 

Answers are provided below 

True or false? 

Question 1: A sentinel event is a patient safety event that results in death, permanent harm or severe temporary harm, or requires an intervention to sustain life. 

Question 2: When a bad outcome or sentinel event has occurred, it is best to wait for a formal complaint by a patient before taking action. 

Question 3: Often an apology or explanation may be enough to meet a patient’s expectations or prevent frustration after an unexpected medical outcome.  

 

Answers

Question 1: True. Physicians should follow state department of health reporting requirements for reporting unexpected incidents or sentinel events. 

Question 2: False. When bad outcomes occur, it is critical to reach out to your malpractice insurance provider immediately to discuss the incident and take action within the first few days or hours after an injury has occurred. 

Question 3: True. Honest and open communication are at the core of patients’ expectations following an unexpected medical outcome. 

[1] HIPAA permits a physician to disclose patient information to the physician’s medical professional liability
insurer without patient authorization to help establish a defense against the patient’s professional liability
claim.

01/23

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Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.