AAP: Managing the risk of malpractice claims in the pediatric office

The respective roles of communication, phone triage management, and documentationare essential if pediatricians want to protect themselves from possible costlymalpractice lawsuits, emphasized Gary N. McAbee, DO, JD, Professor of Pediatrics(Neurology) at the Robert Wood Johnson School of Medicine in Camden, N.J.

“Poor communication is at the core of many malpractice cases,” McAbeesaid. He noted not to avoid angry, frustrated patients. Good inter-staff communicationmust also be monitored. Also, special attention should be given to high-risk situationsthat warrant even greater attention to communication, such as a patient with abad outcome or severe disease, or dealing with an inpatient who is not in thepediatrician’s practice.

Furthermore, phone triage is “becoming more and more important,” McAbeesaid. He noted the importance of established protocols, documented training, andoversight, and warned against using non-clinical staff to triage. Those who performphone triage should verify with the patient that he or she understands what wasdiscussed over the phone. In addition, all calls should be documented to somedegree, with some documented more carefully than others.

McAbee highlighted the importance of proper documentation in general as well;nothing should be allowed in a patient’s chart without it being initialedor dated. Also, the pediatrician’s thought process must be transferred onpaper, and done so with enough detail (eg, writing down a patient’s exacttemperature, not “afebrile” or “0”). Although qualityis preferred over quantity, too much brevity in any piece of documentation canalso be a liability. If a patient has a bad outcome, the pediatrician should recorda detailed summary as soon as possible, and should make sure to document any possible“red flags” that may indicate a more severe disease.

If something isn’t documented, McAbee emphasized, it wasn’t done froma malpractice standpoint.