A new year,new opportunities for growth

Reflecting back on my 20 years in risk management, I wonder at times how I got this far. In my first risk position, to my great fortune, my boss Melinda felt it important that I attend the American Society for Healthcare Risk Management (ASHRM) Annual Conference. Flying out of San Francisco in 1996 after the conference ended, I was in awe of the wealth of information available to me through this venue. I was grateful for those in our industry willing to share their expertise and engage me in conversation at an event where I didn't know a soul. I was hooked, and have missed just a few Annual Conferences since then.     

Vicarious liability: Is it an issue for your organization?

Vicarious liability is a very real concern for hospitals and other health care entities. There are two forms of vicarious liability: respondeat superior (liability for an employee's actions) and agency (liability for nonemployees who appear to be the agent of the entity). Since an entity works through its employees, there is little that can be done, in most cases, to avoid respondeat superior liability. Entities need to be aware of the ways in which nonemployees can be perceived to be the entity's agent so that the appearance of agency can be prevented. There are methods to avoid vicarious liability and to deal with it should it occur.     

Diagnostic error: Untapped potential for improving patient safety?

How many diagnostic errors occur? How often do errors cause harm, and how serious is that harm? Do we understand the major causes of diagnostic errors? Really, we don't know how to answer these questions! This article seeks to define a challenge facing all healthcare risk managers, whose usual methods of identifying and analyzing errors have not, and cannot, supply this missing information. What should risk managers do about diagnostic error? Our medical literature acknowledges the existence of a problem, but offers few practical solutions. This article will review some promising theories from the literature regarding how to identify and remediate diagnostic errors, and identify some tools and resources available to risk managers.     

Are unintentional nurse‐attended deliveries a patient safety issue?

Unintentional nurse‐attended deliveries occur on most labor and delivery units. Some precipitous deliveries are unavoidable, but others, occurring after admission with the expectation that the woman's designated provider would attend the delivery are, for a variety of reasons, still attended only by nursing staff. This study was undertaken to establish a benchmark for unintentional nurse‐attended deliveries. Fifty perinatal units were studied with respect to their statistics regarding unintentional nurse‐attended deliveries. Ten of the 50 perinatal units (20%) did not keep statistics on unintentional nurse‐attended deliveries. The average percentage of unintentional nurse‐attended deliveries in the 40 perinatal units that did keep this statistic was 1.38% (range 0–5.3%). This benchmark should be useful as the safety issues for these types of deliveries are analyzed. Audits regarding timing of examinations during labor, practices regarding notification of providers and other communication practices, provider arrival times, and involved personnel should help perinatal units develop policies, protocols, and strategies to minimize the chances for unintentional nurse‐attended deliveries when there should be enough time and appropriate communication to allow the woman's provider to be present at the delivery.