Telephone advice for neurosurgical referrals. Who assumes duty of care?

Abstract

The rising rate of litigation against all specialities provides an incentive to develop risk management strategies. Much of a neurosurgeon's workload is telephone advice, which is rarely documented formally. This leaves us vulnerable to other clinicians' interpretation of our advice, their record of our conversation and poor accuracy of recall by both parties. We performed a prospective study of all telephone conversations with referring clinicians over 1 year, in order to assess the quality of information transfer. We found that the information received was often inaccurate, documentation of our given advice was poor, and criticism of neurosurgical care was unfounded. We have developed a proforma to be faxed back to the referring team. This will ensure that the information received, and the advice given in return, is recorded formally by both teams. Only time will tell if a joint record such as this will provide sufficient defence against litigation.

Telephone consultations

“…In a good telephone consultation a person will receive information that allows him or her to manage a disorder at home and understand when further advice should be sought. Use of written protocols or agreed standards, as well as following guidance from the defence unions, can help to reduce the risk of liability 23. Quality and safety should be closely monitored and evaluated by, for example, recording calls (with consent from the patient).…”

A qualitative study examining tensions in interdoctor telephone consultations

“…Interdoctor telephone consultation therefore has become an integral part of medical practice. Breakdowns in communication during telephone consultations, however, can occur 12 and have even been a cause of litigation 13 . Despite the widespread use of telephone consultations and the problems described with the exchange, like other forms of interprofessional communication, the skill of telephone consultation has not been formally addressed in medical training 14 .…”

A web-based referral system for neurosurgery – a solution to our problems?

“…Worryingly, Cartmill and White demonstrated telephone advice given from their neurosurgical unit was either completely omitted or unintelligible on inspection of the referring unit's patient notes 4 . Telephone advice is reliant on the referrer's interpretation and documentation.…”