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TopOrganization Background
The Controlled Risk Insurance Company (CRICO) is a patient safety and medical malpractice company owned by and serving the Harvard medical community since 1976. Their mission is to Protect Providers and Promote Safety. For 40 years, the CRICO has provided industry – leading medical professional liability coverage, claims management and patient safety resources to its members.
In September, the CRICO AMC- PSO convened a group of experts to identify and analyze potential and emerging patient safety risks associated with virtual care. This Virtual Care Task Force was focused on:
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Establishing a framework to analyze potential and emerging patient safety risks associated with virtual visits.
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Identifying contributing factors that may increase patient safety risks in virtual care.
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Identifying risk mitigation strategies to support safe and reliable virtual care.
The outcome of their work is a new guidance document, Patient Safety Guidance for the Virtual Visit.
TopCase Description
To assist providers in the optimal delivery of virtual care, three main topics were addressed.
Technology Concerns
Managing the technology can introduce added distractions in the visit. Difficulties with the technology can lead to 1) gaps in the diagnostic evaluation, 2) inadvertent privacy violations, 3) vulnerability to cybersecurity threats, and 4) overlooking essential elements of a care visit. Also, the guidance document encourages organizations to develop formal orientation and onboarding programs for providers, education to raise awareness about technology risks (including security risks such as phishing and hacking), and how to easily access real-time IT support when transmission disruptions occur.
Pre-Visit
Pre-visit preparation should be considered, including acknowledging a potential need for the patient to remove articles of clothing (based on type of visit) or preparing the patient for any potential intra-visit activity such as standing up and walking across the room to test gait and stability. Also setting expectations about privacy, acceptable locations for a virtual visit, and how much time is available for the visit are all important. Another area for careful consideration is guidance for the provider to determine whether it is necessary to convert a virtual visit to an in-person encounter. Assessment of visual and auditory barriers, language issues, and the possible cognitive decline in elderly patients also need to be considered. If the patient clearly struggles, the provider may want to consider converting to an in-person appointment, or whether the patient is open to alternatives that may include having a family member or caretaker present to assist the patient.