PHYSICIANS' RECIPROCAL INSURERS
Risk Management Department
Loss Prevention Technique © 1995

(January - March 1995)
Volume VIII Number I

When patients are discharged from their hospital stays or ambulatory surgery facilities, it is generally with instructions to see the discharging physician within a specified time period after discharge. Although most patients do in fact call the physician's office to make those appointments and are indeed seen in a timely fashion, from time-to-time after discharge, by which time a problem may have already developed. This issue is of great concern, especially in the current climate where hospital stays are shorter than they used to be, thus making it very important that patients have timely follow-up visits with their physicians.

The concern from the physician's perspective, it that (s)he may not be aware that the patient has not been seen by the physician and therefore, is not receiving the necessary follow-up care (e.g. patients who are advised to see the physician in 4 weeks who are not seen for 2 months or more). This is particularly troublesome if the patient had a procedure or illness for which close monitoring is warranted.

Therefore, physicians with these types of patients, should have a mechanism in place, by which the physician can notify the office staff each day about patients who are seen out of the office, for example in the Emergency Department, or were discharged, and indicate to them the time frame for follow-up care. A list of these patients should be maintained by the staff and if, after a reasonable period of time, the patient has not called for an appointment, the patient should be contacted to schedule an appointment. Physicians who do not have such a mechanism in place should consider establishing one.

It may be that a patient has forgotten the physician's instructions for follow-up, and a simple reminder will bring that patient into compliance. However, where a patient refuses the appointment or appears otherwise non-compliant, then the staff must advise the physician, so that (s)he can decide what efforts are to be made to help bring the patient into compliance. (Please refer to PRI's Loss Prevention Manual for information on handling non-compliant patients and those who miss appointments).

It is important that contacts with the patients as well as attempts to do so, are documented at the time they occur. This is because if a patient suffers a preventable injury due to lack of post discharge follow-up, the physician must be able to document his/her efforts to try to ensure that the patient understood the importance of the recommended care.

In some cases, a physician may provide in-hospital care to a service patient or other patients whose care after discharge it to be provided by the hospital clinic or other provider. The plan for follow-up care after discharge must be made clear to the patient and must also be documented in the medical record.

Also, it is not unusual for physicians to request certain studies for patients while they are hospitalized, and not receive those reports before the patients are discharged. Clearly, if the result may indicate the need for continued hospitalization, the physician must ensure that the report is indeed reviewed before the patient is discharged. Even in those circumstances where the report is not likely to change the physician's plan to discharge the patient, the discharging physician must still ensure that all pending reports are received and reviewed. One way to do that, is to make a note of this and advise you office staff of the pending report(s) when you advise them of the patient's discharge. The office staff member can then follow-up with the hospital to ensure that the reports are received in a timely manner.

Below is a list of our Loss-Prevention Techniques:

Telephone Matters | Patient Relations | Test Results and Follow-up Monitoring Patients | Patient Follow-up
Guidelines for Comprehensive Office Chart
Emergency Prepardness | Developing Telephone Protocols
Medical Office Personnel | Medication Matters
Issues in Physician Coverage
Discounting the Doctor/Patient Relationship