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130 PART 1: An Overview of the Approach to and Organization of Critical Care

Patients or their surrogates request access to their medical records
for a variety of reasons, ranging from curiosity to serious question- KEY REFERENCES
ing of quality of care. A physician who is informed of a patient’s or • Boyle D, O’Connell D, Platt FW, et al. Disclosing errors and adverse
surrogate’s request for access to records should offer to go through events in the intensive care unit. Crit Care Med. 2006;34(5):1532-1537.
the record with the patient or surrogate, explain matters, and answer • Castillo LS, Williams BA, Hooper SM, et al. Lost in translation: the
questions. In short, treating the circumstance as an opportunity to unintended consequences of advance directive law on clinical care.
bolster or correct real but perhaps unnoticed problems in communi- Ann Intern Med. 2011;154(2):121-128.
cation between the physician and the patient/surrogate, rather than as
a personal affront calling for defensive posturing, often can pay risk • Choong K, Cupido C, Nelson E, et al. A framework for resolving
management dividends by preventing at an early stage potential mis- disagreement during end of life care in the critical care unit. Clin
understandings that would otherwise eventually manifest themselves Invest Med. 2010;33(4):E240-E253.
as legal actions. • Giacomini M, Cook D, DeJean D, et al. Decision tools for
life support: a review and policy analysis. Crit Care Med.
2006;34(3):864-870.
RISK MANAGEMENT • Happ MB, Swigart VA, Tate JA. Patient involvement in health-
related decisions during prolonged critical illness. Res Nurs Health.
The hospital’s risk management program—which is designed to identify, 2007;30(4):361-372.
mitigate, and avoid potential injuries and other types of problems that
could result in legal, and therefore financial, loss to the institution— • Kuschner WG, Gruenewald DA, Clum N, et al. Implementation
should incorporate specific activities designed to address patient safety of ICU palliative care guidelines and procedures. Chest.
48
and associated legal risks prevalent in the delivery of critical care. 2009;135(1):26-32.
Particular areas of attention in a critical care–sensitive risk manage- • Luce JM, White DB. A history of ethics and law in the intensive
ment program should include the organization and administration of care unit. Crit Care Clin. 2009;25(1):221-237.
ICUs, the roles and responsibilities of the different professionals hav- • Mangalmurti SS, Murtagh L, Mello MM. Medical malpractice
ing contact with patients in those units, medical records, equipment liability in the age of electronic health records. N Engl J Med.
maintenance, equipment modification, equipment records, analysis 2010;363(21):2060-2067.
of equipment malfunctions, incident reporting, and trend analysis of • Mularski RA, Puntillo K, Varkey B, et al. Pain management within
unexpected incidents. the palliative and end-of-life care experience in the ICU. Chest.
The physician should be knowledgeable about the institution’s risk 2009;135(5):1360-1369.
management program and cooperate with it to ensure appropriate
sensitivity to critical care practices and potential problems and their • Truog RD, Campbell ML, Curtis JR et al. Recommendations for
avoidance or mitigation. The physician should view the risk manager as end-of-life care in the intensive care unit: a consensus statement by
a partner in pursuit of the common goal of providing and, if necessary the American Academy of Critical Care Medicine. Crit Care Med.
proving after the fact, quality patient care. 2008;36(3):953-963.
The single most influential aspect of effective risk management is the • Westphal DM, McKee SA. End-of-life decision making in the
fostering of a positive relationship between the critical care team, led by intensive care unit: physician and nurse perspectives. Am J Med
the physician, and the patient and family. There is a demonstrated cor- Qual. 2009;24(3):222-228.
relation between patient (or family) psychological satisfaction with the • White DB, Malvar G, Karr J, et al. Expanding the paradigm of
quality of the physician-patient (or family) relationship, on one hand, the physician’s role in surrogate decision-making: an empirically
and the propensity to file a lawsuit if a bad outcome occurs, on the other. derived framework. Crit Care Med. 2010;38(3):743-750.
Communicating openly and compassionately, especially acknowledg-
ing both the vast uncertainty that pervades critical care medicine and
the reality that serious medical errors sometimes are committed, is
49
as important a tool in forestalling medical malpractice claims as being REFERENCES
proficient, timely, and conscientious in knowing and practicing techno-
logical information and skills. Complete references available online at www.mhprofessional.com/hall

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