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The risk of hospitalist hand-offs


Communication gaps between co-treating physicians are a major source of patient injuries.

Q. Under new rules proposed at our hospital, lab test reports that become available after a patient has been discharged will be sent directly to the patient's follow-up physician instead of to the hospitalist who ordered them. The hospitalist will inform the follow-up physician that lab tests are pending, and the latter will be responsible for any future treatment based on those test results. The hospitalists favor the plan because by the time the test results are in they may have forgotten the details of the case, or why they ordered the studies. Is this reasonable?

The real question here is when does the hospitalist's responsibility for the patient end, and when does the follow-up physician's begin? In malpractice litigation, courts and juries tend to hold the hospitalist responsible until a satisfactory "hand-off" of the patient occurs.

Suppose the test results warrant prompt follow-up care, and the follow-up physician is away for the week after the patient's discharge? Or what if the test results are delayed in the mail? What if changes in test levels are medically significant compared to earlier studies? Will the follow-up physician appreciate the significance of the current results without a review of the hospital chart?

Another possible complication is that discharge summaries often aren't completed-or available-for days or even weeks after discharge. If the hospitalist can't recall the details of a patient's hospital stay, or why he ordered certain tests, how will the follow-up doctor be able to evaluate the test results and decide on appropriate care if the hospital record isn't complete?

A more reasonable approach to this problem is for the hospitalist who orders tests to be responsible for receiving and screening the results, and ensuring that copies are sent to the appropriate follow-up physician. Based on his knowledge of the patient's hospital care, the hospitalist can determine if the follow-up physician needs to be promptly contacted and alerted to any potentially significant lab results.

For years, studies of malpractice claims have found that communication mishaps are a major source of patient injuries. And insurance industry surveys show that unclear or delayed communication between hospital doctors and follow-up physicians can create liability risks. Unless these communication gaps are closed, the proposed plan for delayed test results should be re-examined.

The author is a risk management and loss prevention consultant in Cloverdale, CA. He can be reached by e-mail at

This department answers common professional liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 973-847-5390 or e-mail it to

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