Supplements

Risk management

Copyright © 2006 Society of Hospital Medicine

Risk management seeks to reduce hazards to patients through a process identification, evaluation, and analysis of potential or actual adverse events. Hazard involves that harm that may occur as a result of healthcare delivery, which may be heightened in the hospital setting due to the higher acuity of patient illness, time pressures, and presence of trainees. Hospitalists should strive to comply with the letter and spirit of all applicable laws and regulations, avoid conflicts of interest, and conduct hospital business with integrity and ethical fervor. Hospitalists should also take a collaborative and proactive role with various services that may include risk management to help reduce risk in the hospital setting.

KNOWLEDGE

Hospitalists should be able to:

  • Explain the legal definition of negligence and the concept of standard of care.

  • Describe the effective components of informed consent.

  • Explain the circumstances requiring informed consent.

  • Describe HIPAA regulations related to patient confidentiality.

  • Explain requirements for billing compliance.

  • Describe other laws and regulations to the extent they are relevant to the practice of hospital medicine, including the Emergency Medical Treatment and Active Labor Act (EMTALA), the Patient Safety and Quality Improvement Act, and credentialing and licensing.

  • Explain how ethical principles can be applied to risk management.

SKILLS

Hospitalists should be able to:

  • Elicit informed consent from patients or surrogates for treatment plans and procedures when indicated.

  • Provide adequate supervision of members of the patient care team, which may include physician assistants, fellows, residents or medical students.

  • Apply guidelines of clinical ethics to patient care and risk management.

  • Compare and minimize hazards of diagnostic and treatment management strategies for the individual patient.

  • Ensure patient confidentiality.

  • Comply with HIPAA regulations.

  • Conduct medical practice and complete chart documentation to meet care needs and billing compliance, and reduce risks through effective communication.

  • Conduct medical practice without violating any relevant laws or regulations.

ATTITUDES

Hospitalists should be able to:

  • Apply ethical principles, which may include autonomy, beneficence, nonmaleficence, and justice, to promote patient centered care.

  • Practice Hospital Medicine to meet or exceed accepted standards of care and reduce risk.

  • Appreciate the importance of prompt, honest, and open discussions with patients and families regarding medical errors or harm.

  • Respect patient wishes for treatment decisions and plans.

  • Respect patient confidentiality.

  • Collaborate with risk management in the required reporting and addressing of sentinel events or other medical errors.

  • Lead, coordinate or participate in initiatives to improve and maintain HIPAA and billing compliance standards

  • Lead, coordinate or participate in initiatives that result in processes of care that minimize risk.

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