Resource Library

The 1996 Health Insurance Portability and Accountability Act (HIPAA) gave patients a right to view and request corrections to their medical records. In the intervening years, the widespread adoption of electronic health records (EHR), patient portals, and smartphone applications have led to an increase in patients accessing their medical records electronically. The digital evolution of the medical record has prompted a number of healthcare professionals and patient safety advocates to promote quicker access to information stored in the EHR.

An online search for the phrase “slip and fall” returns a never-ending wave of advertisements for personal injury lawyers, premises liability insurance products, and risk management services. Absent from this deluge of results is any mention of medical malpractice. Ostensibly, this makes sense. Premises liability and medical malpractice are two separate and distinct categories of negligence.

The reporting of unusual occurrences and adverse events has been a staple of the risk management plan in hospitals and healthcare facilities for many years. Incident and event reports, whether written or oral, are a means of alerting hospital leaders to potential or actual patient harm. These reports are critical to the ongoing identification of risk and the investigation of the circumstances that led to an adverse event. The reports, too, are key to the development of risk mitigation strategies designed to create a safer environment for patients, physicians, and staff. Additionally, the incident report, and the information it contains, is a valuable alert to potentially compensable events and the need for disclosure discussions.

Research indicates that a majority of physicians may be suffering from burnout and that burnout is nearly twice as prevalent among physicians as among other workers in the United States. Who or what is responsible for physician burnout is a complicated question that has prompted a great deal of research over many years. Burnout in physicians has been defined as emotional exhaustion, impersonal reaction to patients, feelings of incompetence, low achievement, and lack of motivation. There are multiple tools to measure physician burnout and wellness. Assessing the problem is a key organizational and personal strategy for ensuring quality patient care and physician well-being.

An unintended retained surgical item (RSI) is an item unintentionally left inside a patient (e.g., sponges, towels, device components, guidewires, needles, and instruments).¹ Among surgical never events, RSI is the most frequently reported to the Joint Commission.² According to the Joint Commission, the most common causes of RSIs include the absence of policies and procedures, failure to comply with existing policies and procedures, and inadequate or incomplete staff education.³ NORCAL Group (now part of ProAssurance) closed claims involving an RSI often involve reporting of correct counts or completed surgeries, despite knowledge of an incorrect count. The following case illustrates an example of how and why RSIs occur.