IMPROVING PHYSICIAN DECISION-MAKING TO REDUCE RISK EXPOSURE

Purpose:   Risk reduction in the outpatient setting has the potential to reduce Preventable Adverse Events (PAEs) with improvements in information availability and standardized medical decision-making protocols. Claims management is often an after-the-event result of frequent lapses in physician handoffs, poor documentation, and inadequate information transfer. Our objective was to evaluate the effectiveness of a multiyear intervention to reduce risk events by improving physician decision-making based on behavior changes in information recording.

 Method:   This decision improvement intervention focused on a surgical group practice consisting of 50 surgeons representing 9 specialties practicing at an 800-bed community teaching hospital. Over a 5 year period all physicians engaged in a common training experience consisting of individual chart audits, reporting of actual and benchmark performance measures, and group review of individual, division and overall group improvement following semi-annual training sessions. Best practice decision process for patient information collection, recording and sharing, specifically after-hours call documentation and informed consent, were established following an audit of existing physician compliance and a simultaneous review of malpractice claims conducted by the groups liability carrier. Open reporting of audit results was mandated with pre and post changes reviewed at division and group meetings. Training sessions used actual malpractice claims (appropriately redacted) experienced by the surgeons in order to increase salience and included active physician presentation. Pre and post testing was done through chart audits conducted by outside nurse reviewers using written protocols for chart review. On-call communication requests were recorded separately and then matched to chart documentation by date and time.  

Result:  This intervention produced a 67% reduction in claims frequency over the five year time period, a 74% reduction in average claims paid per year, a 36% reduction in premiums in the last two years of the program, 98% provider satisfaction, improvements in re-audit results of informed consent and after-hours documentation of between 50-75% (depending on individual physician and/or surgical sub-specialty) with sustained results meeting or exceeding benchmarks.

Conclusion:   Improved clinical decisions and a reduction in PAEs based on improved recording and transfer of relevant clinical information is achievable, cost-beneficial and sustainable.