CP/MIH No Show

A legal duty is an obligation imposed requiring adherence to a standard of reasonable care and is a key component to any professional healthcare liability claim.  Accordingly, when a medical provider establishes an appointment for a home visit, the provider accepts a legal duty to provide reasonable care for the patient.  In an instance where a patient has confirmed they will be home during a pre-determined period of time but does not answer the door, the provider may have a duty to determine if the patient has experienced any harmful event. 

During the recent VFIS Risk Control Survey, it was noted your organization has established a community paramedicine (CP) program which includes home visits.  While appointments are set in advance and confirmed prior the arrival of the CP provider, there is not a written guideline for “no shows” in place.

VFIS recommends the development a formal guideline for addressing patient “no shows.”  These patients are enrolled in the CP program because they are at risk for future medical events. As a result there should be a high index of suspicion the patient may have suffered a harmful event. Your organization should develop a procedure for these situations which may include, but is not limited to the following:

• Attempt to reach the patient by phone
• Attempt to reach any emergency contact(s) by phone
• Contact the PCP/referring physician/hospital program affiliated with the CP program
• If safe, a walk around the residence or attempt to peer into windows, etc. to see if patient is visible
• Listen for any signs of distress such as yelling for help
• Check with neighbors to determine if they have seen the patient recently
• Contact law enforcement for assistance with a “welfare check”
• Contact local PSAP to determine if any calls for assistance were recently placed from patients address

Your organization should make all reasonable efforts to determine if the patient in the residence and unable to answer the door.  All efforts should be documented and retained as part of the medical record for the patient.  A procedure for following up with the referring physician/hospital should also be established.

Please contact VFIS Risk Control services for additional information relating to this recommendation.