The Verdict Is In! 2021 Q3 edition

Bouncebacks, Biases, Bad Documentations and Outcomes

A score of 75% or higher on the 4-question quiz will earn you 0.25 AMA PRA Category 1 Credits TM, and a score of 100% will enter you in The Mutual's quarterly raffle to win $300 in VISA gift cards. The raffle winner will be drawn and announced on September 30th, 2021. The survey will remain open for CME through July 30th, 2022. Enter your name/email at the end of the survey for credit and your CME cert will be uploaded into Vituity University.

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Vituity is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.
Credit Designation
Vituity designates the internet enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Disclosure
No one in a position to control the content of this educational activity have any relevant financial relationships with ineligible entities to disclose.

Question Title

* 1. The fundamental purpose of documentation is first to aid continuity of care and enhance patient safety. Billing/reimbursement is another aspect, as well as defense if your care is called into question. Why were experts critical of the documentation on each of the first three visits?

Visit 1: Inaccurate medical hx, lack of neuro exam for a cc of H/A, no discussion of why labs were performed and what the explanation was for the abnormalities

Visit 2: Conflicting HPI and ROS (template), poor description of the abdominal rash which on autopsy was labeled as cellulitis. A pulse ox of 93% in a healthy, non-smoker is not normal. MDM had many typos making hard to decipher what the physician was trying to say

Visit 3: Was the arm pain on her right or left? The inaccuracies give the impression the pt’s complaint was not taken seriously and the physician’s evaluation was sloppy. The headache was not addressed, the new onset of rash from the day before was not looked for on exam or discussed, and the abnormal labs from prior visits were not taken into consideration

All the above

None of the above

Question Title

* 2. The essence of the plaintiff’s claim was the lab results and v/s obtained in the ED were underappreciated as indicating an ongoing infectious process. Infection should have been on the differential for all visits, and some experts felt care was substandard because the providers failed to act on the lab results and abnormal v/s. Other experts were more supportive as there were no definite clues to an infectious process on the visits. Which physician did all experts feel had the most exposure in terms of liability?

ED Visit 1

ED Visit 2

ED Visit 3

ED Visit 4

Question Title

* 3. When a patient has recurrent visits, what is best practice?

Providers should review prior records and address the findings (i.e.: rash, headache, abnormal labs)

Diagnostic progression. Providers should consider more work-up, instead of less, including probing deeper with the patient’s reported history

Faced with a patient with successive, recurrent visits for similar issues, you must document clearly an MDM that supports the decision to discharge instead of escalating work-up or obtaining consultation towards admission.

All the above

Question Title

* 4. Biases affect our understanding, actions, and decisions around patient care and diagnostic errors are often the result of multiple interconnected biases. What types of potential biases could have been unconsciously present in this case?

Requiring Dilaudid. Taking oxycontin for pain. Could this pt be drug seeking?

Obesity. Do I inherently have bias due to societal stigma associated with unhealthy weight?

Staff discussion “just an fyi… This pt has already been seen here 3x this week”. Providers may take this warning the wrong way leading to an impression of the patient (and potential judgment) before seeing them - instead of a heads up to take more time and care to ensure patient safety.

All the above

Question Title

* 5. (This does not require an answer. Copy/paste the links).

Two short education articles for your review:

1)    Medicolegal documentation summary:
https://www.cordem.org/globalassets/files/curricular-toolkit/medico.legal/documentation.summary.handout.pdf

2)    Cognitive bias and its influence on clinical Diagnosis:
https://cdn.mdedge.com/files/s3fs-public/Document/May-2018/JFP06706366.PDF

Question Title

* 6. Contact information for entry into the raffle

Name

Primary Site

Email Address

Phone Number