Liability risks for physicians and medical professionals.

Author: Gallagher National Risk Control, Mary Stoll


Inadequate follow-up care is not only a patient safety issue but also a liability risk for physicians. Common areas for lapses in follow-up care include communication, patient compliance, follow-up on tests and the tracking of referrals.

Poor communication of test results can have serious implications. For example, a patient presents with symptoms of Lyme disease. The diagnosis is confirmed after the appropriate tests. However, due to a system error within the practice, the physician is not informed of the results. The diagnosis is delayed, causing the postponement of the patient's treatment.

Failure to diagnose and delays in diagnosis claims are often attributed to inefficient or non-existent tracking and follow-up systems.

How do you close the gap?

Work with your practice manager and staff to discover any "holes" or inefficiencies in handling and tracking follow-up care. In the hospital setting, investigate/make sure you are familiar with tracking and follow-up protocol. The goal is to prevent clinical information from "falling through the cracks."

Test Orders: Be sure that test orders are communicated, completed and that all results are relayed to the clinician. Have procedures in place to ensure that the clinician or nurse communicates the test results to the patient.

Appointment cancellations and no-shows: This is another area where poor communication can result in a delayed diagnosis or worse. The goal is to assist your patients in keeping up with their medical care. Some tips for cutting down on missed appointments:

  • Have a procedure in place to follow-up on missed appointments.
  • Be sure the physician is informed of patients who miss their appointments.
  • Utilize reminder calls the day before appointments.
  • Make follow-up calls to patients who have missed appointments, followed by a letter.

Referrals to specialists are an important part of patient care. The goal is to ensure your patient is receiving specialized care when it is needed. The report from the specialist should be obtained and reviewed by the ordering physician, who should then communicate any findings to the patient. Make certain your office keeps track of specialist appointments and findings. Verify that procedures are in place to alert you to whether or not a patient was seen by the specialist, and follow up with the patient to confirm they have seen the specialist.

Hospital discharge follow-up. Monitor out-going referrals: Medical record documentation needs to show efforts to follow up with patients who:

  • Were discharged from a health care facility and required ongoing care
  • Missed or canceled an appointment
  • Did not return for recommended care

"If you ordered it, you own it." Patients need to be encouraged to take responsibility for their health care and partner with you towards this goal. However, as the practitioner, you have a prominent role in encouraging your patients to be responsible for their health care. Be proactive, and educate them on the reasons for follow-up appointments and problems that can occur with non-compliance. Document your attempts and patient responses to your efforts to provide your plan of care.

Telemedicine can be a beneficial option for follow-up care for patients who have difficulty with transportation to in-person visits. Patients may also want to benefit from the convenience. For example, monitoring chronic conditions by sending blood pressure or blood sugar levels remotely in between visits is an advantage.

Add layers of safety for follow-up care:

Train the office staff in your processes - for example, an unsigned test=red flag. Your staff should know how to address these issues.

Inform patients they will be notified of all results, but instruct them to call the practice if they do not hear from you within a set amount of time.

Schedule follow-up appointments at check-out for those patients who need diagnostics or consults.

Non-compliant or difficult patients:

Keep a "pulse" on those patients who miss, cancel or neglect to schedule a necessary appointment.Attempt to address the cause of non-compliance. If these efforts are fruitless, you may want to consider dismissing the patient from your practice.

Post-hospital discharge:

Discharge protocol should monitor patients' compliance with post-discharge recommendations.

Remember to document the medical record with patient non-compliance, such as the patient's refusal to get a test, x-ray, or consult. Document all follow-up attempts.

Author Information:


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