Abstract
Introduction
Establishing a patient-physician relationship creates a duty to meet the standard of care for inpatients and outpatients. Growth in burn ambulatory care, workforce changes, and the digital age of healthcare communications have broadened the definition of the patient-physician relationship and increased ambulatory medical liability especially when patients fail to follow-up (FTF). To mitigate this risk, many professional liability insurers have advised physician practices to implement processes to ensure appropriate follow-up and communication. Our study reviewed a multidisciplinary quality and performance improvement initiative to reduce risk from FTF with a goal to improve patient engagement.
Methods
In response to notification by our medical professional liability insurer, a multidisciplinary team of burn specialists reviewed, designed, and implemented a FTF risk reduction program at an ABA-verified burn center. Burn surgeons, physician assistants (PA), nurses, schedulers, and administrative assistants contributed to the development of the FTF protocol. Patients were discharged with follow-up date and time from inpatients stays or at the conclusion of outpatient encounters. If a patient had a FTF event, three attempts were made to contact the patient starting with the scheduler, followed by the nurse, and finally the PA or MD. Each attempt was documented in the EMR. Compliance with the FTF protocol was monitored twice monthly as a component of the burn quality and performance improvement program. Outpatient encounters were abstracted from the EMR into three categories: completions, cancellations, and FTF over a 4-month period prior to implementation and 4-month period post implementation.
Results
Our analysis included over 2,678 outpatient physician/PA encounters. Prior to implementation patients were intermittently contacted with no consistent processes or documentation in the EMR. Staff compliance with the FTF protocol improved from 83% the first month after implementation to 100% by the fourth month. Interestingly, the failure to cancellation rate remained stable while the failure to follow-up rate declined from 15% prior to implementation to 13% post implementation. Patients failing to follow-up commonly stated that they forgot or had transportation challenges.
Conclusions
FTF protocols are essential to engage patients and reduce ambulatory professional liability. Patients will continue to face FTF challenges with language barriers, transportation issues, natural disasters, and even the pandemic. This study was not designed to reduce cancellations or FTF as it is reactionary. Additional work is needed to reduce all causes of FTF and to improve outpatient engagement.
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