Safety of care
Improving patient safety and reducing risks
Suggested approaches to help avoid difficulties in maternal postpartum care, based on expert opinions in a review of CMPA cases.
eConsultation and eReferral services can offer exciting benefits, but to use them successfully physicians should know the areas of potential medical-legal risks so they can be avoided.
While the challenges facing IMGs can be formidable, resources are available to help.
Considerations to help prevent and mitigate the damage arising from ransomware attacks to computer systems.
When asked by patients to interpret or take medical action on direct-to-consumer genetic test results, physicians’ best response is to practise sound medicine and follow the profession’s standards of care.
Disruptive behaviour in the healthcare workplace can take a toll on co-workers and patients, but conflict may be reduced by using a disarming approach.
Physicians in their first 5 years of practice are often unfamiliar with the regulations and guidelines of their medical regulatory authority (College) and find themselves in medical-legal difficulties as a result.
Laparoscopic surgery requires advanced surgical technique, experience with specialized equipment, and dynamic and complex clinical decision-making.
Online social networks in healthcare provide a means for worldwide collaboration among physicians, but participants should maintain the standards of professionalism expected of the profession.
The use of a surgical safety checklist should decrease the risk of adverse events and surgical complications by fostering a patient safety mindset and encouraging team communication.
Physicians should speak with patients about their alternative medicine treatments and, as much as possible, provide guidance on potential negative interactions.
Physicians can take these steps to maintain a safe office environment for their employees.
Physicians can take steps to mitigate the medical-legal risks of patients taking photos and making video and audio recordings during healthcare encounters.
Physicians wanting to communicate with their patients using patient portals should consider the steps they can take to mitigate risks and ensure that portals are used properly and successfully.
Physicians who are familiar with regulatory requirements governing organ and tissue donations can more effectively meet their obligations and mitigate the potential for complaints.
Physicians regularly encounter patients or family members who behave aggressively and make demands that may be unrealistic and potentially harmful. In their medical practice, physicians need strategies and tools to manage conflict and such challenging behaviours.
An overview of obligations and issues for doctors when providing or discussing vaccinations with patients or legal guardians.
Experts in CMPA cases make suggestions on how physicians who work in shifting practice settings can manage risks when providing follow-up care and monitoring medication.
The management of elder abuse cases is an increasingly important aspect of physicians’ practices, though determining the appropriateness of actions to address suspected abuse can be challenging.
The quality and safety of obstetrical care can be strengthened when all members of the collaborative care team are fully integrated in the functioning of the unit.
How physicians can take steps to minimize medical-legal risk when using mobile health applications (mHealth) in their practice.
Wellness strategies and resources for physician residents
The CMPA’s review of medical-legal cases that involved issues with antibiotic prescribing provides insight into opportunities for improvement in the areas of patient assessments, communications, and patient monitoring and follow-up.
The safe use of opioids in the hospital setting requires strategies to safeguard patients from harm and must involve all healthcare team members.
Situational awareness is an essential skill for all healthcare providers, particularly those working in high-risk, continuously evolving clinical environments such as labour and delivery.
A review of main issues and new trends in medical tourism and how physicians can minimize risks in treating patients who seek medical tourism in Canada and abroad.
End-of-life treatment decisions can be difficult for both physicians and patients, but many issues can be avoided by following the key concepts outlined.
An examination of coordination of care in the ICU and the importance of good communication.
The management of obstetrical emergencies relies on effective teamwork and communication between members of the care team.
Medical regulatory authorities are making more information about physicians available to the public. This article provides an overview of this trend, and explains how the CMPA helps members.
A review of medical-legal cases involving severe hyperbilirubinemia in newborns highlights the need for better understanding of treatment and adherence to published guidelines.
Physicians should understand the role of coroners and medical examiners in Canada,
and how and when to provide information to them.
Physicians can work collaboratively with physician assistants, but should be aware of the potential risks inherent in this working relationship and how these can be managed.
Patient handovers can be a time of high risk. Patient safety experts recommend various strategies to improve the performance of this task.
Requirements for consent and other lessons learned related to the use of restraints on patients from a review of CMPA medical-legal cases.
Protecting the privacy of patient information when using digital communication channels, including email, portals, and social media platforms.
Physicians in non-surgical disciplines who perform invasive procedures may be exposed to medical-legal risks, though these can be effectively mitigated.
This article focuses on the main areas of medical-legal risk for otolaryngologists (ENT specialists) based on the CMPA’s case files and on safety measures that can be taken to mitigate those risks.
Meningitis poses a significant risk of death and disability, especially in vulnerable populations. Prompt diagnosis and treatment is critical.
Learn how Canadian physicians can meet the care challenges posed by immigrants with a number of specific approaches.
Common medico-legal issues for physicians related to the repeated prescription of opioids for patients with pain unrelated to cancer.
Videoconferencing is a valuable tool in healthcare today, though in-person patient consultations are still necessary in many circumstances. Using videoconferencing appropriately improves safety and reduces risk.
A review of medico-legal cases related to stroke, outlining some of the challenges in diagnosis and providing suggestions from experts to improve care and reduce risk.
Hip or knee arthroplasty can greatly improve quality of life, yet it may also have significant risks.
Missed or delayed diagnosis of a serious medical condition is often related to inadequate assessment and physical examination, cognitive biases, and deficiencies in the system of care.
Physicians who treat or who are asked to treat transgender individuals should be aware of the ethical and legal considerations in these circumstances to avoid allegations of discrimination.
Considerations for ending the doctor-patient relationship.
Early recognition and treatment of sepsis are imperative to prevent patient harm and medico-legal difficulties for physicians.
Providing medical care to athletes has unique aspects. Physicians doing this work should be aware of potential medico-legal risks and take steps to keep their patients and themselves safe.
Physicians who reduce or limit their clinical workload to attend to other commitments, for example conducting research or transitioning into retirement, are still obligated to provide patients with continuity of care.
Physicians can take steps to help prevent abuse of the opioids they prescribe, while improving safety for their patients and reducing their own medico-legal risk.
After day surgeries, consider if patients are ready for discharge, require accompaniment on leaving the facility, and have sufficient discharge and follow-up instructions.
Issues to consider when communicating with patients via email: confidentiality, timeliness, clarity and consent.
Strategies for successfully implementing changes in medical practice aimed at improving the quality and safety of care.
Increasingly medical education is focusing on physician competencies that address safe patient care and that enable more accurate assessment of performance.
This article discusses the culture of safety and describes system-level strategies for safe care.
Healthcare safety improvements are contingent on identifying and mitigating risks both at the system and individual levels, and physicians should be aware of such risks in their practice
Drawing on the expertise of numerous organizations and resources dedicated to improving healthcare safety, healthcare providers can make changes to care practices and reduce the potential of harming patients.
How to enhance safety and overall outcomes when treating patients with chronic diseases, while reducing the exposure to medico-legal risks.
An analysis of recent CMPA cases highlighting the medico-legal risks associated with surgical ureteric injury.
Physicians can take specific actions to support patients’ engagement in their healthcare.
Tips to assist physicians in communicating effectively with patients and their families when a patient’s prognosis is terminal.
Physicians’ office staff can contribute to safe care for patients and reduce medico-legal risk. This article reviews several issues identified in the CMPA medico-legal files and provides suggestions on reducing risk.
A review of hospital-based patient safety incidents and common reasons leading to them.
Physicians practising telemedicine across Canadian provincial or territorial boundaries should be familiar with the applicable licencing and regulatory requirements in their own jurisdiction and in their patients’ jurisdiction.
Physicians can take steps to avoid conflicts of interest that can arise when dealing with commercial interests.
Misidentifying a patient is a risk and can result in harm.
A review of medico-legal cases involving healthcare-associated infection, and risk reduction strategies to consider.
Diagnostic assessment issues related to back pain, based on the experience of CMPA members.
Adequate discharge strategies to help reduce the risk of unplanned hospital readmissions, unfavourable patient outcomes, and medico-legal problems for physicians.
Specific risk management strategies for physicians who are providing care to patients experiencing mental health issues.
Strategies to help mitigate risks for physicians who work night shifts.
The potential future impacts of social media usage on physicians’ practices.
When patients suffer harm from healthcare delivery, physicians will want to disclose the incident to the patient, and if the media become interested, then prepare appropriately.
Advice for physicians facing journalists or negative news coverage.
Tips to help physicians participate appropriately in using social media.
Advice for physicians acting as media spokespersons
Physicians should be aware of the pros and cons of social media and the risks of participating.
When a patient seeks a second opinion about a diagnosis or treatment plan, the other viewpoint will confirm, modify, or offer alternatives to the initial one, and ultimately the patient is free to decide.
An examination of medico-legal risks with fetal heart monitoring in the antepartum and intrapartum periods.
Physicians can successfully manage online ratings using a reasonable and measured approach.
Considerations when determining a patient’s need for a medical test or procedure.
Highlights of medico-legal issues associated with anaesthesia and analgesia administered by anesthesiologists for surgery and during labour and delivery.
Physicians have an obligation to protect patient information and can take steps to help prevent privacy breaches associated with sending and receiving faxes.
Physicians can help contribute to quality of care in long-term care facilities by being mindful of communication issues, coordination of care (including medication reconciliation and management), consent to treatment, advance directives, and regulatory requirements.
This article focuses on the main areas of medico-legal risk for psychiatrists.
Measures for reducing medico-legal risk in the diagnosis of traumatic compartment syndromes of the lower limb, based on 5 years of CMPA members’ experience.
Physicians are advocates for their patients and for healthcare improvements, but this dimension of medical care can be challenging. This article explores what advocacy means and what approaches are most effective and appropriate.
Effective communication and awareness of legal requirements are key to obtaining consent for treatment of children.
This article explores the role of physicians in promoting the exchange of information and active decision-making by patients. It also examines the relationship between decision-making and consent.
Appropriately obtaining, interpreting, documenting, reassessing, and acting on vital signs are important parts of medical care.
This article discusses what physicians can do to deliver culturally competent and culturally safe medical care.
How to better manage the risk of patient harm, adverse birth outcome, and potential medico-legal problems associated with the administration of oxytocin during labour.
By communicating effectively with pharmacists, physicians can improve patients’ drug therapy and provide safer care.
When working with nurse practitioners, physicians should understand the scope, responsibilities, and accountabilities of these independent healthcare providers, and should communicate clearly and in a timely manner.
What can be done to reduce the medico-legal risks for physicians when patients do not heed their advice.
Physicians play a key role in managing medication. Careful attention to risk management strategies will help physicians provide quality care for their patients.
Timely diagnosis and treatment depends on obtaining sufficient clinical information, monitoring the situation, and thinking ahead.
Physicians need accurate and up-to-date information to provide effective and safe patient care, but information overload can create distraction rather than improve knowledge.
Physicians acting as clinical supervisors play a valuable role in the remediation of physician colleagues and, as members of the CMPA, are eligible for the Association’s assistance if medico-legal difficulties arise.
Physicians can take a number of actions to reduce the risks in diagnosing prostate cancer and following-up on test results.
This article focuses on the main areas of medico-legal risk for radiologists, based on the most recent 5 years of CMPA members’ experience.
Administrative and management practices, data sharing agreements, confidentiality agreements, and privacy impact assessments can help physicians to achieve compliance with their privacy obligations.
Physicians should carefully reassess patients who return with symptoms that are not resolving as expected or are worsening.
Steps physicians can take to help patients with poor health literacy skills.
The increased availability of genetic testing raises a number of medico-legal questions that physicians should consider.
Highlights from CMPA discussion paper “The role of physician leaders in addressing physician disruptive behaviour in healthcare institutions.”
A sample of medico-legal questions posed by CMPA members to physician and legal experts at the Association's education programs.
Physicians can make their transition into retirement easier for all those affected, particularly patients, by making preparations well in advance and giving ample notice.
Advice and tips on managing conflict, based on CMPA's experience in medico-legal matters, the medical literature, and consultation with experts. Practice management considerations are also discussed.
A review of CMPA medico-legal cases involving feeding tube placement identifies clinical situations of higher risk that can affect patients and physicians.
Appendicitis in many cases remains difficult to diagnose. A review of CMPA medico-legal cases identifies many of the challenges.
This article explores the role of physicians in the organization of integrated health systems such as regional health boards, health authorities, and health networks.
Physicians practising in rural and remote areas should be aware of the medico-legal risks in these circumstances.
An overview of the medico-legal risks of caring for patients with co-morbidities.
An analysis of issues relevant to the diagnosis of cervical cancer and based on the 10 most recent years of CMPA closed medico-legal cases.
Physicians should expect that at some time they will have to manage a medical emergency in their office or clinic. Planning, preparation, and practice are key steps in mounting an effective response for both patients, and physicians and their staff.
Clarity about who is responsible for the care of a patient at any given time improves patient safety and reduces medico-legal risk.
Physician leadership and participation are essential for successful quality improvement efforts in healthcare.
Assisting prospective parents seeking to adopt a child from abroad can pose challenges for physicians, particularly when they are asked to assess a child’s condition without a physical examination or to prescribe medication for a child with whom they do not have a doctor-patient relationship.
An analysis of the CMPA’s pediatric medicolegal cases identified a
number of common factors that resulted in poor clinical outcomes.
Effective management of test results and diagnostic imaging reports in a hospital setting can improve patient safety and mitigate risks.
A review of medico-legal problems associated with hernia repairs in the preoperative, intra-operative, and post-operative stages.
Physicians assume key responsibilities in healthcare including the provision of much needed medical care, research into new treatments, teaching the future generation of doctors, and managing healthcare facilities, centres, or clinics.
As healthcare delivery relies increasingly on integrated or collaborative care, a growing number of physicians are working in teams composed of physicians and other healthcare professionals.
Trust, loyalty, and honesty are the foundations of a good doctor-patient relationship and of professionalism in the practice of medicine.
Medico-legal issues for ophthalmologists related to the pre-operative, intra-operative, and post-operative periods of cataract surgery.
Strategies to reduce medico-legal risk when prescribing medications or using medical devices outside of their licensed indications.
A review of medico-legal cases concerning diagnosis and management of skin cancer.
Physicians considering various arrangements for practising medicine, other than the privileges-based model, need to consider any medico-legal implications.
As the healthcare environment continues to change, physicians remain committed to quality patient care, while keeping in mind accompanying risk management considerations.
Engaged and empowered patients take an active role in managing their healthcare, and physicians must be aware of the medico-legal implications.
Risk management lessons from a review of medico-legal cases related to venous thromboembolism prophylaxis.
A review of the medico-legal issues with bariatric surgery in the pre-operative, intra-operative, and post-operative periods
Risk management suggestions related to verbal and written communication in the trauma setting and when resources are limited.
Physicians should learn about the benefits and medico-legal risks of each new information technology platform before considering using these web-based tools
Physicians should be aware of the medico-legal risks that are inherent in practising in a community care location.
Trauma care in the emergency department — Early diagnosis a key factor in improving patient outcomes
Risk management suggestions from an analysis of medico-legal cases related to the diagnosis of trauma patients.
Canadian physicians can take steps to ensure continuity of care for patients engaged in medical tourism, and avoid medico-legal risk.
If physicians have reason to believe a child is in need of protection, they are responsible for informing the appropriate authority in a timely manner. Planning what to say to the family is important.
Physicians should be prepared to respond to patient enquiries about complementary and alternative medicine and natural health products.
A review of medico-legal problems related to malfunctions, improper use, and deficiencies in training and supervision when using medical or surgical equipment.
As the Canadian population ages, physicians may need to adjust their practices to better meet the needs and expectations of older adults and avoid potential medico-legal risks.
A review of a five-year period of medico-legal files related to infectious endocarditis.
Physicians can find themselves in a difficult ethical and legal position when patients refuse to be treated.
Changes in the relationship between physicians and hospitals may have medico-legal implications that could lead to difficulties for physicians, institutions, and patients. Recommendations to address these implications are identified.
In legal proceedings where courts are determining if the care provided met the standard of care, authoritative clinical practice guidelines may be considered as one piece of evidence.
There are a number of steps that can be taken to reduce the likelihood of patient dissatisfaction with Independent Medical Evaluation.
A discussion on how members can help meet the clinical, emotional and informational needs of patients after large scale adverse events.
Limiting patients to one issue per visit can lead to negative perceptions if not communicated with respect and diplomacy.
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians.
A review of medico-legal problems related to prescribing and monitoring medications for older patients.
There is growing evidence that effectively managing the results of test and diagnostic imaging reports improves patient safety.
Most physicians agree that clinical practice guidelines (CPG) can improve the quality of clinical care. In a legal case, however, a court may place more weight on the standard of care of a "prudent colleague" than on a CPG.
A review of medico-legal problems related to patients who are unknowingly pregnant and have been exposed to investigations and treatments recognized to possibly harm a fetus.
An analysis of medico-legal cases indicates that there are several possible reasons for delays in the diagnosis of SAH. Delays in diagnosis may result in medico-legal risks.
A discussion of how physicians can improve their inter-professional communication skills, leading to better care for patients and reduced medico-legal risks for physicians.
A case illustrates why it is important to take a sufficient history during a telephone call.
When providing advice informally to others or over the telephone, obtain sufficient information on which to base your professional opinion, as they may rely on the advice.
Acute chest pain is a common, chief complaint in both an emergency department and family practice environment. Careful evaluation of the history, physical examination and ECG may provide valuable clues. In some cases, observation and further testing may also be advisable.
Physician-patient
communication is a critical
aspect of effective care that
may be enhanced with these
suggested approaches.
Suggestions to reduce risk and optimize the timely diagnosis of lung cancer.
A review of some of the medico-legal risks related to the use of medical directives in emergency departments, and patients who LWBS by a physician or sign out AMA.
A just culture of patient safety promises better quality and safer care. This article explores protected quality improvement reviews and discusses the benefits of learning from adverse events to limit the likelihood of their reoccurrence.
A review of complications and ways to mitigate risks related to cholecystectomies and other laparoscopic procedures.
A just patient safety culture promises the provision of higher quality and safer care. Advice is provided to CMPA members on participation in reporting and reviews of adverse events and close calls in hospitals and institutions.
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on intestinal complications.
Potential liability issues for physicians working with independent health care professionals, and steps to mitigate those risks.
Intoxicated patients pose special risks in the emergency department because of their behaviour, and the difficulty of adequate assessment and treatment.
A review of medico-legal cases involving complications of cholecystectomy. This article focuses on biliary tract injuries.
A review of closed medico-legal cases alleging delays in the diagnosis and management of breast cancer, focusing on patients presenting with clinical findings suggesting a possible lesion of the breast.
It is well recognized that health care providers continuously strive to ensure the best possible clinical outcomes for their patients. They do so cognizant that no one individual or system can ever fully eliminate the risk and occurrence of adverse events
Delays in the diagnosis of ectopic pregnancies may lead to poor patient outcomes and medico-legal difficulties for physicians.
An overview of the medico-legal difficulties associated with the use of anticoagulant, antiplatelet and thrombolytic agents
Physicians should carefully consider the meaning and implications of indemnification clauses in contracts with employers, research organizations, governments, health care agencies and others.
Clear communication among patients, referring physicians, technicians and radiologists, as well as attention to details in follow-up, will permit optimal outcomes from screening programs for breast cancer.
A review of legal actions involving physicianprescribed opioids.
Issues to consider when discussing vaccination with patients.
Hyponatremia may occur during rehydration or with maintenance fluids, and can have serious adverse effects, including neurologic impairment and death.
Aminoglycosides are effective antimicrobial drugs but can have serious adverse effects. Indications, alternatives, dose, duration and co-morbidities are some of the important considerations.
Although most physicians are aware of the possibility of compartment syndrome following trauma to a limb, it may occur in other situations.
Physicians discharging patients in need of follow up care may have certain responsibilities.
This risk identification paper identifies six areas associated with potential delays in the diagnosis of colorectal cancer.
Before giving advice on medical matters, even informally, physicians should be satisfied they have considered and documented the relevant information.
Physicians may find it prudent to seek assistance from credible sources when patients seek pre-travel advice about, or later present with symptoms after travel.
Appropriate use of aminoglycosides requires awareness of the potential side effects and their symptoms.
The diagnosis of aortic dissection may be complicated by an atypical presentation, but careful documentation and appropriate reassessment can reduce the associated risks.
Quality improvement activities can be expected to improve patient care, but care should be taken to avoid undue medico-legal risk.
It is right to express sympathy after an adverse event, but an apology with acceptance of blame may be inappropriate.
It is important to consider testicular torsion in young males presenting with abdominal or scrotal pain.
Timely, unrushed disclosure of adverse events to patients is an obligation that may strengthen the doctor-patient relationship.
It is important to properly dispose of test reports.
In a shared care environment, consider liability issues, the scope of practice and qualifications of other team members, and the importance of good communication.
Privacy legislation affects physician's collection, use and disclosure of personal information.
A study examining the medico-legal risks of airway management by anaethesiologists from 1993 — 2003.
Steps to create a safe working environment.
Carefully document telephone advice even if a patient rejects it.
Adequate record keeping may help during a billing audit.
Exercise caution in repeating prescriptions.
Monitoring medications in shared care.
Notifying and transferring patients and medical records when making a practice transition.
An inquiry into the Canadian blood system recommended improved documentation and informed consent, and decreased allogeneic blood use.
Clear messages regarding physician availability help reduce medico-legal risk.
The proper disposal of materials such as sharps is important.
Physicians can rely on hospital staff to carry out their own functions but are also expected to exercise appropriate caution.
Physicians may be expected to provide appropriate advice to referring physicians even when their facility cannot accept the patient.
Although spinal epidural abscess is rare and difficult to diagnose, it can have serious consequences for patients. CMPA experience has been reviewed.
House calls place the doctor in an unfamiliar situation where it may be more difficult to obtain a history or to perform a physical examination.
A physician's remarks about prior care may lead to medico-legal difficulties for a previous care provider. It is important to base any comments on a thorough knowledge of the facts.
Clinical care is increasingly provided by collaborative teams with the promise of better outcomes for patients. This document identifies potential medico-legal risks in collaborative care and proposes solutions to lessen those risks for patients and providers.
Pathological examination of a surgical specimen is the mid-point of a complex process involving many people. Mix-ups can occur at any point in the process, with adverse effects for patient and difficulties for health-care personnel.
Certain practice management issues arise when a physician dies, and should be considered as part of estate planning.
The Courts expect physicians to provide appropriate care to patients, making use of available resources. Physicians can be discussing limitations with patients and may discuss concerns and options with other physicians and administrators.
Cauda equina syndrome is not common, but has the potential for serious and long-lasting disability. Knowing the symptoms and signs, examining the patient adequately, and obtaining timely and appropriate investigations and consultations may help to avoid the risk of disability.
The diagnosis of symptomatic abdominal aortic aneurysms is challenging. A review of medico-legal cases related to patients presenting with this diagnosis in emergency departments is presented, with risk management considerations.
Failure to diagnose thoracic aortic dissection is not always due to negligence.
Considerations for consultants and referring physicians with regard to wait times.
DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.