By Ted Abernathy, MD, Managing Partner, Pediatric & Adolescent Health Partners

As healthcare becomes increasingly complex, doctors work hard to ensure the best possible outcomes for their patients using the most proven procedures and standards available. Many healthcare organizations find value in engaging outside experts who can view their practice from a new perspective and identify risks doctors and staff might have overlooked.

Research on the frequency and severity of malpractice claims from The Doctors Company, the largest physician-owned medical malpractice insurer, underscores the importance of a thorough, objective practice review. While the number of claims against physicians has been dropping since 2003, the fact that 7 out of every 100 physicians in the U.S. face a claim each year is still unacceptably high. And while we may not be facing as many claims as in the past, the average cost of a claim—defined as a request by a patient for payment—has grown from $69,000 in 2003 to $100,000 today, according to The Doctors Company.

Without an independent evaluation, practices face deficiencies in communication, documentation, and tracking that can increase exposure to risk. Errors may be blamed on poor performance rather than viewed as opportunities to make improvements.

As managing partner of Pediatric & Adolescent Health Partners headquartered in Midlothian, Virginia, I read about various risk assessment services and felt we could benefit from taking a closer look at our practice to identify risk factors and gaps in patient safety protocols. While I was confident we were minimizing risks appropriately and adequately, I was less confident in our ability to prove it. Our practice was expanding and I wanted to ensure we had consistent operational systems in place across locations to foster patient safety.

An assessment service offered by The Doctors Company provided our practice with a comprehensive checkup of key areas and a customized action plan. A patient safety/risk manager spent more than half a day at our practice reviewing medical records and procedures for test tracking, appointment setting, telephone communication, informed consent, and other areas.

She reviewed records and diagnoses from each of our providers, and interviewed the entire staff and physicians. The management team encouraged the staff to be open and honest during the interviews, and explained that the information collected was designed to improve patient safety and reduce risks, not punish current practices.

The findings were presented to clinicians and office administrators, and communicated to the entire 51-member staff in a collaborative, supportive manner. The patient safety/risk manager was thoughtful, caring, and thorough, and put the staff at ease that the program was not intended to find fault, increase premiums, or reduce insurance coverage.

Our management team prioritized the recommended actions and implemented several enhancements—many related to improving communication and making better use of our electronic health record (EHR) system's capabilities. Our customized action plan included:

• Setting up a system that allows staff to capture information digitally and send a summary of phone conversations with pediatric patients' families within seconds via e-mail or text. This ensures the correct information is communicated to the caller without ambiguity, and becomes part of the patient's EHR.
• Instituting periodic chart reviews to ensure diagnosis codes are supported and medical records accurately describe the patient's symptoms and history.
• Starting a peer review committee as a means of ensuring continuous performance improvement.
• Using a digital system to better track patient referrals to specialists and whether patients were following through with appointments.
• Digitally tracking whether reports from ordered labs and other tests are getting back to the office. Changing from a handwritten system to a computerized one increases accuracy and assists with follow ups, which strengthens patient safety.
• Monitoring medications more accurately through a medication reconciliation process that documents at every appointment whether patients are continuing their prescribed regimen or have stopped or altered it. The responses are included in the patient's EHR.

These changes have better equipped our practice to minimize risks and have enabled us to prove that the practice is grounded in patient safety. Based on management's discussions with the staff, employees have more confidence that protocols and standards are working as intended, and feel more empowered to highlight opportunities for improvement and work together to achieve goals. By doing so, we can anticipate issues before they become problems, and can focus on what matters most—providing the best care to our patients.