By Mary-Lynn Ryan, JD ProAssurance Senior Risk Management Consultant
Communication failures among members of the health care team can lead to patient harm, which can prompt malpractice lawsuits. Common scenarios in these suits include refusing requests to examine patients and not exchanging adequate patient information during report and hand-off. Another example is assuming patient well-being despite information available that indicates a problem. The case study below highlights the need for health care team members to develop effective communication strategies, especially during team conflict. (Although the setting of the case study is labor and delivery, the communication issues highlighted can occur in any healthcare setting.)
A patient at 34 weeks gestation presented to labor and delivery (L&D) reporting decreased fetal movement. The L&D nurse noted minimal variability in the fetal heart monitor (FHM) tracing and no response on vibroacoustic stimulation (VAS). She contacted the on-call OB, who ordered an ultrasound and Lactated Ringer’s but dismissed the nurse's suggestion of a biophysical profile (BPP). The nurse obtained a BPP anyway and reported the 4/10 results to the OB, who admonished her for not following the original order. The nurse expressed her concern for fetal well-being and requested the OB's immediate presence at bedside. Two hours later the OB arrived. He ordered betamethasone and continued observation. The infant was delivered via C-section two hours later. Apgars were 0/2/5 at one, five, and 10 minutes. The child was later diagnosed with cerebral palsy and profound intellectual disability.
The parents’ lawsuit, which focused on the OB, alleged the delivery delay caused the infant’s injuries. Defense experts were not supportive of the OB due to several issues. One issue was the OB’s delay in examining the patient in response to the nurse’s communication of concerning FHR, VAS, and BPP results. The OB’s defense was also complicated by finger-pointing between him and the nurse, who blamed each other for the poor outcome. Further, the plaintiffs witnessed the nurse’s telephone conversations with the OB in which she urged him to examine the patient. The finger-pointing and testimony about the telephone calls were expected to reflect poorly on the OB in front of a jury. The case was ultimately settled due to these various issues, which would have made prevailing at trial unlikely.
To prevent similar incidents and improve patient safety, consider the following strategies:
Proactively monitor patient progress.
Thoughtfully consider challenges to your treatment plans.
If attempts to resolve conflict fail, take steps to address them within the hospital's organizational framework.
Address conflicts with team members in a private area.
Change your communication style if it is likely to be regarded as dismissive or confrontational.
Participate in team communication and collaboration training.
Although organizational factors can frustrate communication, in many malpractice claims communication failures can be traced to individuals on the plaintiff’s healthcare team. A common theme in these claims is passive attitudes toward obtaining patient information. This manifests as failure to evaluate patients with adequate frequency, ask questions, provide information, and voice safety concerns, among other things. Why these failures occur is not always apparent, but they can often be attributed to causes such as distraction, fatigue, over-commitment, fear, and overconfidence. Communication is a team endeavor, which often requires team training to achieve proficiency. It requires the individual and collective commitment of every team member and the institution in which the healthcare takes place.
For Further Reference:
Agency for Healthcare Research and Quality, Pocket Guide: TeamSTEPPS 3.0, Revised May 2023
“Effective Followership: A Standardized Algorithm to Resolve Clinical Conflicts and Improve Teamwork,” Journal of Healthcare Risk Management
The information provided in this article offers risk management strategies and resource links. Guidance and recommendations contained in this article are not intended to determine the standard of care but are provided as risk management advice only. The ultimate judgment regarding the propriety of any method of care must be made by the healthcare professional. The information does not constitute a legal opinion, nor is it a substitute for legal advice. Legal inquiries about this topic should be directed to an attorney.
