Wednesday, January 12, 2011

Professional Indemnity Tip #1: Appointment Management

By Heather Martin. Risks to your patients’ safety and wellbeing reside in many places – in your rooms, the operating theatre, on the wards and at home. Some of these risks are avoidable and/or within your control.

The following risk management ‘quick-tips’ address medico-legal risk in relation to appointment management. The appointment system is an integral component of any practice. It goes beyond the basic organisation of the daily consultations by:

  • Supporting patient care and safety
  • Contributing to time management
  • Enhancing patient satisfaction and compliance
  • Providing forensic evidence in the case of a factual dispute

Orientating new patients to your practice’s appointment management processes can:

  • Enable the exchange of important information between practice and patient
  • Notify the patient of the services/access they should expect from your practice
  • Reduce the likelihood of any mismatch between a patient’s expectation of service/ care and what you can provide
  • Reduce the likelihood of patient disappointment and complaints arising from these unmet expectations
  • Support patient safety by ensuring patients have information regarding alternatives in cases of emergency

A patient’s time is valuable and while they can be understanding of unavoidable delays, unexplained delays can be perceived as rude or dismissive. It is of course not always possible to forewarn patients of unexpected delays, however on arrival it is good practice to provide your patients with:

  • Information about any delay – an explanation and expected waiting time
  • An apology for the inconvenience caused
  • Options – i.e. wait, re-schedule etc

Keep your patients informed if the original waiting time changes. Observing these common courtesies means patients are less likely to enter your consultation room annoyed or frustrated.

When patients routinely experience delayed appointments as opposed to the occasional unavoidable delay, this may be indicative of more entrenched problems in appointment scheduling procedures and/ or practitioner time management skills. Those issues that are within your control should be addressed to minimise patient dissatisfaction.

Regularly running behind time can create a whole new set of problems, including rushed appointments, inadequate history taking, overlooking important issues or cues, and inadequate documentation of the consultation.

Your appointment system is a useful tool in assisting with patient follow-up and the monitoring of at-risk patients. It can be used to generate flags and recalls of patients. ‘Did not attends’ and cancellations should be followed up to ascertain the reason for failed attendance – this is particularly relevant for patients with serious or insidious conditions.

All no-shows should be communicated to the doctor, as the patient may require further medical assessment or treatment. Where you believe follow up is appropriate, document all attempts by your practice to contact the patient.

The appointment record also contains important information about patient compliance with your treatment recommendations and is often relied upon in cases of a factual dispute between doctor and patient.

Heather Martin is the Risk Management Services Manager at MDA National. MDA National is a mutual Medical Defence Organisation (MDO), founded in Perth, WA in 1925 to protect the interests of its doctor Members. You can read more of Heather's articles under Professional Indemnity.

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