Heightened malpractice risk for hospitalist physicians in the USA: what to know and what to do.

Hospitalists, nurse practitioners, physician assistants and institutions are all at risk for the potential professional liability issues. The unique relationship between healthcare providers and their sponsoring institution generates complex and evolving legal issues for all participants. The law has played a great role integrating quality care and patient safety with physicians, while providing an avenue for relief when a medical error occurs. The intersection of law and medicine, while allowing for optimal patient care, exposes participating medical providers and the sponsoring institutions to specific professional liability issues. This article addresses the heightened medical practice risk that hospitalist physicians' encounter in today's practice of hospital medicine.

Benefits of Pharmacist's Participation on Hospitalist Team.

This study was performed to assess the incidence of medication errors and irrational use of human albumin in two wards of our hospital and also aimed to evaluate the ability of pharmaceutical care center and pharmacists in improving patient care. Albumin administration was evaluated for patients who received albumin during the study period, in gastroenterology and general surgery wards. The indications for Albumin administration were evaluated on the basis of reliable guidelines. The prescribing errors were simultaneously evaluated by reviewing patients' medical records. Prescribing errors were defined as selecting improper drug (based on indications, contraindications, known allergies, drug-class duplications and drug-drug interactions), dose, dosage form, and route of administration. It was found that 465 containers of human albumin solution 20 % were used for 54 patients treated in gastroenterology and general surgery wards of our hospital. A total of 306 (65.81%) vials of the albumin administrations were in concordance with the reliable protocol. The cost of irrational use of this drug (159 vials) for patients is equivalent to $ 8215. From 609 reviewed cases, 81 prescribing errors were detected in 64 patients. This study showed that the pharmacists were effective in identifying irrational drug use and medication errors.

The hospitalist: better value in inpatient care?

From perhaps a few hundred practitioners in 1996 to an estimated 30,000 today, the discipline called hospital medicine has shown remarkably rapid growth. It represents a fundamental separation of the inpatient and outpatient components of internal and family medicine. The split has implications for the quality and efficiency of care delivery, the outlook for the physician workforce, and the development of new models such as accountable care organizations (ACOs).

Reflexiones sobre el papel del médico en la guardia intrahospitalaria / Reflections on the role of the physician in in-hospital duties

La guardia médica es un pilar fundamental en la asistencia hospitalaria moderna. La mayoría del tiempo que un paciente permanece ingresado está bajo su cuidado. Prácticamente no existe información sobre los aspectos clínicos de la misma. En ella tienen gran influencia el propio paciente, su familia, otros enfermos y sus acompañantes, hostelería, diversas situaciones especiales, personal de enfermería y el médico en su doble vertiente como responsable del enfermo y como médico de guardia. Como responsable del enfermo el médico debe tener en cuenta diversos aspectos sobre el control del mismo, la toma de decisiones y facilitar la labor de la guardia. Como médico de guardia debe tener claro cuáles son sus objetivos, lograr una buena gestión de las llamadas que recibe, tomar las decisiones que le corresponden y facilitar la labor del médico responsable del enfermo. Asimismo, hay que analizar y adecuar la carga de trabajo sobre el médico de guardia (AU)

The physician on-call is a fundamental support for modern in-patient care. The majority of the time during which a patient is in the hospital, he/she is under their care. There is almost no information about its clinical aspects. These are greatly influenced by the patient, his/her family, other patients and their relatives, catering services, some special situations, nursing personnel, and the doctor both as the main responsible person for the patient and as the physician on-call. As the doctor on call, he/she should have a clear idea of what the objectives are, achieve good management of the calls received, make the difference corresponding decisions and help the work of the patient's responsible physician. It is necessary to analyze and adapt the amount of work that the physician on-call has (AU)

[Competition between office-based physicians and hospitals--general legal conditions]. / Wettbewerb zwischen niedergelassenen Arzten und Krankenhäusern--Gesetzliche Rahmenbedingungen.

Before December 31, 2002 hospital options were limited to demand-oriented individual authorisations and ambulatory emergency care, so there was no competition against private practice physicians. For the first time the Healthcare Reform Act (GSG) provided hospitals with the opportunity to offer ambulatory services from January 1, 2003 in individual areas of care (pre- and post inpatient treatments according to Sect. 116a SGB and ambulatory surgical interventions according to Sect. 115b SGB V). Following numerous reform acts the spectrum for hospitals has been considerably extended today, particularly by establishing medical service centres (MVZ) and the authorisation to provide certain ambulatory services according to Sect. 116b para. 2-6 SGB V after special approval. Conversely, an amendment of Sect. 20 para. 2 Aerzte-ZV from January 1, 2007 enabled office-based physicians to be employed in a hospital and provide inpatient care so that today we may speak--at least in important sections--of a competitive situation on different levels.

[Administrative procedures in cases of medical errors: the jurisdiction of the hospitalist]. / Procédure administrative en cas de faute médicale: la juridiction du médecin hospitalier.

The administrative jurisdiction is, with the exception of free practice within hospitals, that which judges whether actions of hospital doctors are at fault, and evaluates the harm done to the plaintiff. After a reminder of the fundamentals of medical liability as regards the administration, a short update on private practice in hospital, and the notion of fault being separate from the hospital function, the author analyses the important elements such as the concept of the preliminary decision and the status of the expert, and then a number of characteristic elements of this type of procedure, stressing in particular the absolute necessity of a perfectly kept hospital medical record.

Key legal principles for hospitalists.

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.

Key legal principles for hospitalists.

In a hospitalist system, when a patient leaves the hospital, he or she will return to a primary care provider (PCP) for follow-up and continuing care. The hand-off after discharge can compromise communication with the PCP. Physicians have a legal duty to provide follow-up care to patients with whom they have a relationship. The obligation to provide follow-up care endures even when the patient misses a scheduled appointment or does not adhere to the follow-up regimen. In general, the physician who began the care must fulfill that obligation. An essential component of follow-up care includes educating the patient about what symptoms require follow-up care and why it is important. The duty to provide adequate follow-up care is shared by the hospitalist and the PCP. Virtually no malpractice case law considers the obligations and practices of hospitalists. This article uses cases involving follow-up care for patients treated in an emergency department and general cases regarding liability for follow-up care to examine the potential legal obligations of both hospitalists and PCPs for follow-up care, including circumstances involving pending test results and incidental findings.

Ethical and policy implications of hospitalist systems.

Hospitalist systems raise ethical and policy concerns regarding informing patients about the hospitalist system itself, communication between primary care physicians and hospitalists, continuity of care, and conflicts of interest. Patients may worry that hospitalist systems are intended to achieve cost savings and that the role of the primary care physician as coordinator of care may be undermined. These concerns may be particularly salient for certain subgroups of patients. Hospitalists and health-care organizations that set up hospitalist systems should take steps to reduce the foreseeable risks that discontinuity of care might cause. Practice standards should be set for communication between primary care physicians and hospitalists and for involvement of primary physicians in inpatient care under certain circumstances. By setting such standards and monitoring performance, hospitalist systems can improve the quality of care and reassure patients.