Risk Management for Hospitalists

In their roles as inpatient caregivers, hospitalists must balance multiple responsibilities while treating medically complex and unfamiliar patients. This page outlines key risk management strategies for hospitalists, including patient interaction and interdepartmental communication. We’ll also explore the critical areas of documentation and patient discharge.

Patient interaction

Hospitalized patients often feel vulnerable and anxious, which can affect their ability to process and retain information. This makes communicating with these patients challenging. Follow these strategies to help ensure effective communication.

• Quickly establish your role and name. Set clear expectations about your role.  
• If part of a group, consider using a “guide” to the physicians and providers in your group (with photographs) that can be shared with patients.
• Acknowledge the stress/pain/discomfort the patient is experiencing.
• Use phrases like “I know we’re meeting for the first time, but I’ll do my best to treat you.”
• Show you’ve reviewed available information: “You were admitted through the ER for ...”
• Confirm information about allergies, current medications, and recent health care visits.
• Document all sources of patient history (patient reported, family, EMS, outside records).
• Note when the patient’s history is limited or unclear due to patient condition.
• Include family members/support people in conversations when authorized.
• Use teach-back methods to confirm patient understanding of treatment and discharge instructions.
• Provide clear written discharge instructions in patient-friendly language.

Caregiver communication

A breakdown in communication between members of the health care team can lead to adverse outcomes. Communication between caregivers is especially critical during shift changes and at discharge. Here are targeted risk management strategies for improving communication among caregivers in the hospital.

• Establish clear channels of communication with consulting specialists.
• Clarify roles and responsibilities when multiple specialists are involved.
• Acknowledge and respect each other’s expertise and input.
• Document all interprofessional discussions and treatment decisions.
• Be clear about the timing of any ordered tests or consultations, using the facility’s preferred terminology (“STAT” versus “ASAP” versus “urgent.”) Note response times for critical services.
• Take steps to follow up on pending test results if not available within expected timelines. Follow escalation procedures for patients who have not undergone ordered testing or who require urgent follow up.
• Follow clear handoff protocols for shift changes and for transfer between hospital units.
• When possible, conduct in-person handoff communications in areas free of interruptions.
• Maintain relationships with key department staff members and consultants.

Discharge

Because patients are more susceptible to medical errors when transitioning from inpatient to outpatient settings, coordinate care with primary care physicians as needed. Send pertinent medical records — discharge instructions, medication lists, and postoperative care plans — promptly to facilitate effective communication. Follow hospital protocols for patients who do not have a primary care physician.

Ensure patients know who follow up with after leaving the hospital. When possible, ask for assistance from hospital staff in setting up appointments with outpatient providers. Provide clear, written instructions with specific dates or timeframes and criteria for seeking immediate medical attention. Verify understanding by having patients verbalize the follow-up plan before discharge.

Establish clear protocols for tracking and following up pending test results and critical findings that emerge post-discharge. Establish protocols for contacting the patient and outpatient physicians with results when necessary. Identify any radiology study discrepancies between initial and final reads, and act quickly to notify physicians or patients when needed.

Documentation best practices

The urgency and complexity of inpatient care can make it difficult to follow good documentation practices. Consider these recommendations.  

• Incomplete or late documentation means other physicians may not have access to information needed for treatment decisions and continuity of care. This gap in communication could lead to duplicate testing, medication errors, or missed follow-up care. Delayed documentation can compromise the accuracy and completeness of the hospital record.

• Ideally, documentation should be completed as soon as possible after patient encounters. Include clinical findings, assessments, treatment plans, rationale for diagnostic decisions, and differential diagnoses when applicable.

• Document any discussions with consulting physicians and hospital staff about a patient’s test results, treatment, and recommendations. Document detailed handoff communication for complex cases.
• If you use templates for EHR documentation, be sure information is updated to accurately reflect the care provided. If using scribes, review notes before signing off.

‍