Ethics/Responsibilities of Approach to Less-Than-Optimal or Poor Care (or Perceived Malpractice), Analysis, and Follow-Up
Policies, such as contracts, should be developed between the agency that provides the transport team and the organization (eg, hospital, clinic) that request transport that clearly define the responsibilities of each during the course of the transport.
In this manner, members of the transport team will not find themselves in disagreement with the referring physician about care to be provided to the child before or during transport. This arrangement respects the autonomy of all and clearly delineates responsibility for decision making. With clear delineation, the following could be avoided: the transport team may believe intubation is necessary for a safe transport, and the referring physician may disagree and not allow them to perform the procedure. In the absence of such policies, transport team members should attempt to engage the individuals with whom they disagree in a respectful and honest discussion about the differences in the transport environment that require procedures not necessary in the inpatient environment to be performed. If patient condition allows, this discussion should occur away from the child and the child's family to maintain confidentiality. The welfare of the child should always remain the primary focus. If an agreement cannot be reached through respectful dialogue, the transport team should contact medical control and have the medical control physician speak with the referring physician.Occasionally, transport team members will have concerns about clinical care given to a patient before or during transport. They may have questions about their obligations to provide feedback to the person who gave the care in question or to notify the patient or family that they suspect harmful or deficient care was given or that mistakes were made.
Although honesty and transparency regarding mistakes is important, transport team members rarely have a full understanding of the many factors that may have affected care provided before their arrival. In most cases, transport team members should avoid making premature and misinformed judgments about the care given by others. The focus initially should be on the care of the patient and stabilization of the patient's condition. Once transport has been completed, there should be a clear and direct mechanism for communicating concerns to the provider in question, collecting the necessary data to determine whether care was appropriate, and providing a formal means for review of the data and remediation, if necessary. Family members should be notified about errors or deficient care, but only after an adequate investigation of the facts has determined that this occurred.
More on the topic Ethics/Responsibilities of Approach to Less-Than-Optimal or Poor Care (or Perceived Malpractice), Analysis, and Follow-Up:
- Long-Term Rehabilitation Follow-up
- Optimal Muscles to Study for Rest Activity
- Ethics of Research During Transport