Patients put their trust in physicians and advanced practitioners to have the experience, technology, and resources necessary to provide the best care possible. And providers have a legal obligation to fulfill that expectation. When that doesn’t occur, poor patient outcomes typically follow resulting in a negative patient experience at a minimum. For providers, the result can lead to costly and potentially career-ending lawsuits.
One notable area of concern is emergency handoffs during a telemedicine visit. Breakdown of communication and missteps in this delicate transition can easily result in “breach of duty” lawsuits.
There are three duties providers are expected to perform wrapping up a visit:
- Activation of emergency services for patients and/or potential victims who have threatened harm or suicide
- Verbal and written communication to successfully hand off patients between healthcare providers
- Ensuring the hand-off of care is complete with the appropriate provider when emergencies happen
[CALLOUT] Breach of duty liability is the same for telemedicine as it is for in-person visits, but emergencies during telemedicine can be particularly dangerous.
The disconnect
There are more than 5,700 primary and secondary Public Safety Answering Points (PSAPs) in the U.S. Unfortunately, 911 personnel can only dispatch the first responders located within the caller’s PSAP zone. Because of the disjointed nature of the 911 system, calls cannot be easily transferred between PSAPs and textual and priority information is usually lost. This means when a telehealth provider is outside of the patient’s PSAP, one of the only options during an emergency is an online search attempting to find the phone number of the appropriate EMS provider.
[CALLOUT] Searching for the appropriate ambulance provider for the patient’s PSAP takes up precious time that could put the patient at risk. It also inhibits the provider’s control over the transition of care.
In many cases, providers may be tempted to tell the patient to hang up and dial 911 or go directly to the ER but doing so puts the provider at risk of a lawsuit. The provider is conducting the emergency handoff by telling the patient to seek emergency care themselves, which the patient may or may not do or be able to do. It also fails to meet The Joint Commission’s requirement of providing both verbal and written instructions from professional to professional during an emergency handoff. It would be the patient’s word against the providers in a court of law. Patients who are physically or mentally impaired during a telehealth visit may not remember the provider gave verbal instructions to go to the ER. Without evidence that the handoff occurred, the provider can be liable.
A new approach
Some steps can be taken to reduce liability and the potential for poor outcomes when a provider must escalate to emergency care.
The initial step is for the provider to generate a record of the visit, including video/audio and/or a written transcript of the instructions provided. It is also critical the provider ensures the instructions are clearly communicated in written and verbal formal to local emergency personnel responding to the case. But the most critical step is for the providers to ensure they are contacting the correct municipality’s PSAP and locating the patient.
This critical step, however, can be difficult without the right tools. Fortunately, there is an answer. Providers now have access to technology that leverages web-based platforms enabling quick, effective handoffs to the appropriate PSAP.
How it works
A new 911 technology solution, Telemedicine911, provides geolocation, in addition to verbal and written instructions, directly to the appropriate EMS service. Geolocation is able to find an unresponsive patient or a patient who is stranded on the side of a road in an unfamiliar area.
- Using any device connected to the internet, the provider enters the patient’s name, indicates if it is an ALS (advanced life support) or BLS (basic life support) response, designates a destination facility, and adds any additional information helpful for the emergency responders.
- If known, the provider enters the patient’s location. If not known, the provider can choose the geolocation feature that finds and fills in location information.
- The provider is automatically connected to the 911 dispatcher in the patient’s PSAP. Pertinent information the provider entered is immediately visible on the dispatcher’s screen which has been shown to reduce medical error.
- With accurate, complete information, the appropriate 911 dispatcher ensures the right help is sent to the right location for the right patient.
The ‘best solutions’ generate written documentation to verify every step the provider takes. This documentation is critical for legal defense should a lawsuit occur. The best solutions also give providers the ability to record their calls as proof of compliant handoffs.
High-quality handoffs are vital. They are proven to:
- Decrease medical error by 23%
- Reduce adverse events by 30%
- Decrease near misses by 21%
The time to act is now
Lawsuits are, unfortunately, a part of practicing medicine. And the increased need and popularity of telehealth puts providers at even greater risk. In today’s challenging times, providers need to do all they can to protect themselves and their practices.
Leveraging 911 technology solutions can help. When minutes matter, you’ll be glad you did.
Alexander Chiu, M.D., is chief executive officer of Telemedicine911.
