Case Study: Quality of Care Concerns

Situation:

• A small community hospital finds itself facing increasing concerns regarding the quality of care of its senior family practitioner and #1 admitter
• This physician is a powerful, highly regarded and very litigious member of the community with a long track record of successfully avoiding and combating all previous attempts to address performance issues
• Medical Staff leaders and administration have been at a loss for years to effectively address the perceived concerns
• Agencies external to the hospital (i.e. Workers Compensation) and new medical staff and administrative leadership have again heightened the awareness of the organization to these concerns
• Legal counsel has confirmed potential exposure to negligent credentialling claims
• There is now a new sense of urgency to validate and address the perceived quality concerns or clarify and lay them to rest

QMCG Team Role: Conducted an independent review of the physician's clinical performance using a five step process:

• Physician reviewer selection, credentialling and introduction to subject physician
• Study design including medical record selection and criteria development
• Offsite medical record review, data analysis and trending
• Report development including specifics supporting conclusions reached and suggested approaches for improvement
• Summary conferences with medical staff leaders
• Summary conference with subject physician

Peer Review Study Conclusions: Significant trends demonstrating patient management concerns and documentation issues were documented resulting in the recommendation that the physician should not be managing patient admissions or care independently.

Medical Staff/Hospital Accomplishments: Since receipt of the QMCG report and the summary conferences:

• The physician agreed to an immediate leave of absence from hospital privileges to be followed by announcement of the physician's retirement
• A physician has been recruited to assume the physician's practice
• Patients have been protected
• The physician's dignity has been preserved
• Fair hearing and legal action have been avoided as well as $50,000-$75,000 in legal fees
• Risks for negligent credentialling and malpractice claims have been reduced
• Damaging community relations has been avoided