Page 36 - 2020 Risk Reduction Series Effective Systems_Part 1_Flipbook

SVMIC Risk Reduction Series: Effective Systems

have rescheduled the appointment. In other words, the patient

unfortunately interpreted the cancellation by the physician’s
office as an indication that the follow-up CT scan was not

important and unnecessary. Better communication could have
possibly changed the outcome for this patient.

Another brief example involved a patient who underwent a

cystourethroscopy for complaints of hematuria. Urine cytology
was collected which revealed malignant cells. However, the

report was not transmitted to the office, nor did the lab call the
office to report the critical finding. There was no internal tracking

in place to alert the physician of the missing test result. A return
visit in six months was scheduled, but the patient failed to keep

his appointment. Again, the office had no system to follow-up
on missed appointments. Nearly a year later, the patient self-

referred to another urologist who diagnosed bladder cancer
with brain metastasis.

Physicians frequently ask the question, “How many attempts
to contact the patient will relieve me of liability?” There is not

a one-size-fits-all when it comes to following up on a missed
appointment. The courts will apply a reasonableness standard.

Generally, the reasonableness of the follow-up effort will depend
on the clinical importance of the test results, the severity of the

patient’s medical condition, and the risk associated with failing
to notify the patient of the results and receive the recommended

treatment.

The following paragraphs outline a general process for handling
missed appointments:

When notifying the treating provider of a missed
appointment, staff should include the reason for the visit.

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