RIsk Management for Gastroenterologists

Reducing malpractice risk requires a comprehensive approach that begins with a thorough patient history and informed consent, and extends through careful monitoring and follow-up care. This article explores risk management strategies in gastroenterology and offers practical guidance.

Patient history

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A comprehensive patient history serves as the foundation for safe and effective care. When taking a patient history, consider both GI and non-GI conditions that might affect treatment decisions. This includes:

• previous surgical procedures and complications, including any complications related to anesthesia;
• history of heart or cardiovascular disease;
• family history of GI disorders and cancers;
• current medications, including over-the-counter drugs and supplements;
• allergies and adverse reactions to medications or contrast agents;
• anticoagulation status;
• any history of sleep apnea; and
• social history, including alcohol consumption and dietary habits.

Document conversations and findings in detail, noting both positive and negative responses to key screening questions. This documentation can prove invaluable if questions arise later about treatment decisions.

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Informed consent

Between 2017 and 2021, approximately 60% of medical liability claims for gastroenterologists involved an allegation concerning a procedure. The top patient outcomes (result of alleged injury) in these claims included accidental puncture/laceration during a procedure and intraoperative and postprocedural complications and disorders. (1) Effective informed consent can mitigate the liability for physicians if one of these known risks occurs. Informed consent is a process, not a document. A thorough discussion of risks, benefits, and potential complications is crucial for managing expectations and building trust.

• Explain the procedure in clear, understandable terms.
• Outline specific risks and benefits and discuss alternative treatment/screening options.
• Address patient questions and concerns.
• Document that the informed consent discussion took place, that the patient’s questions were answered, and that the patient agreed to proceed or declined.
• Provide clear pre-procedure instructions, including information about the importance of thorough prep and NPO status.

Informed consent should be obtained not just for procedures, but when prescribing new medications or treatments. When prescribing a high-risk drug with potential for adverse side effects, it is especially important to document that the informed consent discussion took place.

The pre-procedure period is an ideal time to determine and document who will manage medications that must be stopped before and re-started after a procedure (such as anticoagulants). This includes who will monitor any symptoms patients experience during the interruption.

Because patients must at times obtain cardiac clearance before GI procedures, it is good risk management practice to create a tracking system for pending clearances. The system can be configured to set specific timelines for follow-up (for example, after 5-7 business days if no response) and flag any concerning results for immediate physician review.  


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Monitoring and follow-up

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Systematic monitoring and follow-up can help ensure optimal outcomes and reduce liability risks.

• Provide clear, written discharge instructions with specific dates or timeframes for follow-up appointments and criteria for seeking immediate medical attention. Verify understanding by having patients verbalize the follow-up plan before discharge. Document follow-up plans and responsibilities in the medical record.
• Records should be completed as soon as possible after a patient encounter. This increases accuracy and allows important information to be available to all members of the health care team. Quality medical records are not only critical for diagnosis and treatment, but can also assist in the defense of a malpractice claim.
• Tracking and follow up with test results is consistently among TMLT’s top 10 risk management considerations. Having a reliable system that can help track tests and consults until results are received is critical.
• Reports should either not be filed in a medical record or should remain on EMR “pending” lists until the ordering physician has reviewed them and determined the next course of action. When reviewing reports, verify that the correct test was performed and the results were returned. Tell patients to expect that the practice will contact them about tests and procedures, and that they should contact the office if they do not receive results within a specified time frame.
• For patients with multiple specialists, clear communication between physicians is vital to patient safety. Failure to properly communicate can result in lapses in care and incorrect diagnoses and treatment. Consider communicating directly with other consulting physicians to discuss the patient’s history or current condition. Document these discussions in the patient’s record.
• When caring for hospitalized patients, maintain open communication with all members of the health care team, including consulting physicians and hospital staff. Thorough patient evaluation and assessment promote continuity of care for optimal patient outcomes.

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Source

1. MPL Association. Data Sharing Project Dashboard. Data analysis by TMLT. Copyright 2025.

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