My infection preventionists are part of a system . They always have a certified IP at a moment ’ s notice , who will walk them through a situation , and coach them and help them . Not all IPs have that . This is more about nobody goes to work and thinks , ‘ I want to harm patients today .’ We ’ re all here to make things better . But it ’ s that lack of knowledge that could end up in that spot and we as a profession must put our arms around and create opportunities for those people .” that is something that ’ s really difficult if you ’ re not part of a system . My infection preventionists are part of a system . They always have a certified IP at a moment ’ s notice , who will walk them through a situation , and coach them and help them . Not all IPs have that . This is more about nobody goes to work and thinks , ‘ I want to harm patients today .’ We ’ re all here to make things better . But it ’ s that lack of knowledge that could end up in that spot and we as a profession must put our arms around and create opportunities for those people . Our APIC chapter -- that ’ s a big part of mentoring and having that so that if you don ’ t have that in your own organization , you ’ ve got someone willing to put their arms around you outside your organization .”
There is precedent that when a patient wins HAI-related litigation , it turns out to be a case involving the failure to properly diagnose and treat the infection rather than causing the infection in the first place .
“ I think this is really where the delineation between infection prevention and practicing medicine happens ,” Kroll says . “ There is this medical practice piece that as an infection preventionist you ’ re not responsible for , and you may know best practices from a situation like antibiotic stewardship or testing stewardship , so you can offer general but on an individual case you ’ re not going to call the doctor and be like , ‘ Hey , I really think you should be doing X , Y , or Z .’ But from an infection prevention perspective it ’ s preventing and looking at , did we cause that harm , and so really keeping those pieces apart . I think what the person in this article was really getting at is that when it gets to a litigation standpoint , you weed it out . Because what it comes down to with medical judgment , and that ’ s where you have differing opinions and get into that place of , was it the right thing medically to do for that individual .
It comes back to risk recognition , risk assessment skills , and risk mitigation skills .
“ I will tell you that novice IPs and becoming proficient IPs are very risk-averse , and so my experience is often they actually end up on the other side of the pendulum . Whereas a leader , I ’ m like , ‘ Okay , we could engineer the safest situation possible ., but look at what that does to all these other partners that are involved , and how we balance the risk of infection with other things . So , an example of this is , you would think , if a patient has a potentially infectious disease or if I ’ m on the fence about that , I ’ m going to put them into isolation precautions . That way , I am making sure . But what you must realize is the patient who is in those precautions , we know that there are other risks that are associated with that because the word isolation in and of itself tells you the patient is isolated . They receive fewer touches , they receive less face time with the provider team , and depending on the hospital , they might receive fewer ancillary services because they don ’ t see someone who ’ s in those precautions . And so , a novice infection preventionist might say , put everybody in those and leave them there , because that ’ s the safest thing to do . But there ’ s this bigger piece that we must consider . So , I think that risk management is one of those skills that where you get into more gray areas , as you become more proficient as an IP , you become an expert in saying how much risk am I willing to have the organization take on , and can I clearly articulate what that risk is to an operational executive who I ’ m helping make a tough decision .”
Settling vs . Going to Court
As Kroll indicated in her presentation , frequently , litigation is more successfully defended against if the documentation is impeccable .
“ There was a good paper that I read about this that showed that if you had better documentation , the likelihood it would go in your favor was there , so that trend exists ,” she says . “ The challenge with that is , I ’ m coloring in the lines a bit there , because the documentation in question was clinical documentation and in the same vein , infection preventionist documentation around these hospital-onset cases . So much of litigation is around medical management , and less about when a patient contracted an infection in the hospital . That is not necessarily going to change ; I think that we have a real background rate that doesn ’ t reach it to that stage . For instance , in my system , if someone calls our risk management department and says , ‘ Gosh , I think I got this infection at your hospital , and I ’ m really upset about it and I ’ m making you aware that I ’ m seeking recourse on that ,’ my experience is that complaint goes to the infection prevention department to investigate . Did they get this infection in our hospital ? And if the evidence is there that yes , they did , we settle ; we want to do right by our patients . And litigation is so expensive . I ’ m in litigation right now that ’ s been going on for more than 18 months ; the cost is incredible to a healthcare organization . They don ’ t want that ; they would much rather make things right if we actually harmed a patient .”
Some infection preventionists may be concerned that settling indicates guilt .
“ My experience is that it ’ s pretty rare to go to trial , and I think that ’ s why infection preventionists don ’ t necessarily have that lens because they don ’ t see all of these things happening in the media or journal articles , because so often they are settled ,” Kroll says . “ And there is not great data that I could find on how many go through , and how many settlements healthcare does annually . I know from my own experience and I ’ ve said to our legal team before , ‘ You don ’ t want me on the stand as a witness on this . It ’ s not good for the company .’ The data is clear on this that when you make an error in medicine , the No . 1 thing patients are looking for is to feel heard , and to receive an apology , and to understand what we are doing to ensure that this doesn ’ t happen again . I ’ ve had a lot of conversations in tandem with risk management and legal to sit down with a patient and just hear them out , hear what their experience was , as well as say , ‘ We heard you and you are right ; we are so sorry , and this never should have happened , and these are the steps we ’ re taking to make sure that this never happens again .’ Sometimes that ’ s enough . Patients will often say , ‘ I wasn ’ t looking for financial compensation , please don ’ t do this to someone else .’
As Sheridan ( 2024 ) explains , “ Medical malpractice cases generally seek large amounts of monetary compensation , and no matter how small or large the claim , the cost of defending the claim affects healthcare professionals and the healthcare organization involved . Large monetary awards in medical malpractice cases that proceed to a jury trial receive notoriety that , in turn , encourage the filing of medical malpractice claims by others , thus perpetuating the cycle of litigation that impacts the cost of delivery of healthcare and influences
22 • www . healthcarehygienemagazine . com • september 2024