Does No Harm Mean No Deviation?
It is quite common for hospitals to conclude that if a patient was not harmed, there was either no deviation from standard of care or the deviation was of little significance. It is unreasonable to rule out deviations from standard of care on the basis of an acceptable outcome or the absence of patient harm. Driving under the influence of alcohol is not acceptable regardless of whether or not someone is harmed. Similarly, poor clinical performance is not acceptable regardless of the actual impact on the patient.
Conversely, adverse outcomes do not necessarily imply poor care. Yet adverse outcomes should be a consideration for case screening criteria, even though the best of care can lead to undesired results. Effective quality management recognizes that monitoring systems should look not only for patient harm, but also for potential patient harm.
Screening criteria must be sensitive to each specialty as well as to local characteristics. Widely used criteria for focused professional practice evaluation case selection includes, but is certainly not limited to, unexpected readmissions or returns to surgery, sentinel events, adverse patient outcomes, patient complaints, peer concerns, requests for new privileges, abnormal complication rates, unusual or disruptive behavior and aberrant utilization rates. While patient harm is an important consideration, the lack of patient harm should not exclude cases from peer review.
– Jon Moses, President & CEO
Parts of this article were taken from a piece I wrote in 2012 while Principal, President and CEO of MD Review.