Within Normal Limits: Navigating Medical Risks

This episode features Darlene Turner from Healing Hands Community Doula Project, which aims to support expectant mothers, particularly in the Black community, through their pregnancy journey. The grant from the Copic Medical Foundation is being used for a program that trains perinatal community health workers to provide extensive support, including birth and postpartum planning, lactation guidance, family dynamics, and more. This initiative primarily serves Medicaid populations, addressing additional complexities such as Medicaid reimbursement, and aims to improve overall birth outcomes.

Website -- Healinghandscp.org

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Medication errors are traditionally defined as an avoidable event, but they don’t just happen during the prescribing phase. In fact, it’s important to remember that there are many steps—transcribing, dispensing, and administering—where an error can occur. To learn more about pediatric medication errors specifically, we invited COPIC Patient Safety and Risk Manager, Kayla Boyd, to the podcast. In this episode, Kayla looks at the overall process of pediatric medication prescription, from diagnosis to accurate compilation of records to ongoing monitoring. Plus, you’ll hear about ways to avoid adverse outcomes and mitigate risks with young children...

This episode features Liz Warman and Mandy Johnson from the Kansas Health Care Collaborative and focuses on the organization’s transition-in-care program that aims to leverage Health Information Exchange (HIE) to reduce care fragmentation and improve health outcomes by developing processes, workflows, and policies in clinics. This initiative is supported by grant funding from the Copic Medical Foundation and the model used has shown significant efficacy in reducing readmissions. The program received a high level of engagement from clinics and hospitals across Kansas and next steps include creating a rural network of facilities using HIE data, with the goal of...

In this episode, Matt Groves, Copic’s General Counsel, talks about the impact of recent federal executive orders and legislation on healthcare providers. He provides general information about new federal initiatives and their potential risks, emphasizing the rapid changes and uncertainty in the legal landscape. Matt explains the differences between executive orders and legislation, and the concept of federal preemption over state laws. The discussion also covers the executive order on gender-affirming care, its implications for funding, and the potential risks for healthcare providers, including criminal and civil liabilities. In addition, the episode addresses issues related to immigration enforcement an...

The episode features staff from AIRnyc—Lola Simpson, Chief Executive Officer; Kathleen Agaton, Chief Impact Officer; and Lydia Baez, Senior Outreach Coordinator and Community Health Worker. AIRnyc received a grant from the Copic Medical Foundation to support their efforts to reduce fragmentation in prenatal and postpartum clinical and social care for high-risk Black and Latinx pregnant persons. The discussion highlights AIRnyc’s focus on addressing developmental delays in children and implementing a two-generation model for maternal and child health, which involves working with both mothers and children.

Website: https://www.air-nyc.org/

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For this episode, we sit down with Copic’s General Counsel, Matt Groves, to talk about non-compete agreements in the medical field. The discussion starts with looking at the purpose of non-compete agreements such as protecting patient revenue, preventing competition, and safeguarding the investment in recruiting and developing physicians. Matt highlights key legal terminology (e.g., non-solicit, non-disclosure, and liquidated damages clauses), the various ways these agreements are enforced, and how they may vary by state. In addition, he reinforces the importance of seeking legal advice before signing non-competes, especially in situations where you are negotiating terms.

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This episode features Mary Tucker and Garrett Chism discussing an interprofessional education pilot program between Metropolitan State University of Denver and Denver Health. The program is supported by a grant from the Copic Medical Foundation and focuses on simulation training for nursing and EMT students to improve patient outcomes. The objectives include evaluating critical changes in patient assessment, completing trauma assessments, and demonstrating closed-loop communication. A key aim is to teach students from different disciplines to communicate effectively and understand each other's roles to reduce errors in patient care.

Metropolitan State University Nursing Program: https://w...

We welcome Beth Chow, an occurrence nurse with Copic, who provides some great perspective about the benefits and value of early reporting of incidents. Beth explains the interchangeable terms "occurrence" and "incident" and clarifies what constitutes an adverse event and the types of events you should report to your medical liability insurance carrier. She goes on to explain how Copic’s reporting process works, why early reporting does not negatively impact your policy or premiums, and how early intervention programs like Copic’s 3Rs Program and Candor help resolve issues and maintain open communication with patients.

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Links/Resources

U.S. Preventive Services Task Force- https://www.uspreventiveservicestaskforce.org/uspstf/

American Cancer Society- https://www.cancer.org/

American College of Gastroenterology -https://gi.org/

Feedback or episode ideas email the show at wnlpodcast@copic.com

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should exercise their professional judgment in connection with the provision of healthcare services. The...

Amy Herum, a nurse and patient safety and risk manager with Copic, joins us to talk about the purpose and scope of EMTALA. Amy explains the situations that trigger EMTALA obligations and the definition and assessment of an “emergency medical condition.”The discussion then looks at the requirements and process of transferring a patient under EMTALA, the penalties and consequences of violating EMTALA, and the conditions that end EMTALA obligations such as when a medical screening exam shows no emergency medical condition, the patient is transferred to another hospital in compliance, or when the patient refuses examination, treatment, or trans...

Our guest is Anna Barr, a patient safety and risk manager with Copic, who joins us to talk about terminating the provider-patient relationship. The discussion starts by looking at the main considerations before terminating a patient: trying to mend the relationship by using effective communication and conflict resolution skills, assessing the clinical situation, the risk of abandonment, the possibility of discrimination, and the contractual obligations that may apply. Anna then highlights key termination steps such as notifying and assisting the patient, and documentation. She also talks about the benefits of having a practice-wide policy for non-compliance or disruptive behavior t...

This episode features Renee Blattman, a nurse and risk manager with Copic, who has 20 years of experience in the perioperative environment. The discussion focuses on the challenges and risks in this environment—a high-paced, high-volume, and fast-turnover setting, where there is a lot of pressure to keep the patients moving and the OR schedule tight. Renee talks about the growth and trends in ambulatory surgery centers along with the increased risks of discharge and follow-up care, as patients may need more education and support at home. In addition, she highlights how a culture of safety is essential and how th...

In this episode, our guest is Heather Westermeyer, a Patient Safety and Risk Manager with COPIC, and the topic is documentation. Heather highlights the role documentation plays in continuity of care—from ensuring an accurate medical history to supporting communication among providers. She also talks about how documentation serves a key purpose in legal protection/defense in medical liability issues and the importance of articulating your thought process. In addition, the discussion touches on best practices, standardized templates and protocols, and the dangers of copying and pasting.

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LaDonna Kelley, a nurse risk manager with COPIC, is the guest for this episode, which looks at patient safety and risk management for geriatric patients. LaDonna tells a personal story about the challenges with caring for this patient population and how certain situational factors impact their care experience. She mentions issues such as hearing limitations, technology, and mobility and being aware of these during interactions. The conversation also examines communication challenges and the importance of clear communication with geriatric patients.

Feedback or episode ideas email the show at wnlpodcast@copic.com

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In this episode, we talk with Carrie Beth Roddy, a COPIC Patient Safety and Risk Manager, who joins Dr. Zacharias for a conversation on Just Culture. Carrie starts with defining the concept of Just Culture, explaining how it is being integrated into traditional medical culture, and the importance of using it to create opportunities to prevent future medical errors. We dig into the difference between human and system errors, factors that contribute to Just Culture’s success, how it facilitates more open discussions among providers while ensuring the highest level of safe treatment for patients, and ways that it su...

Anna Barr, a nurse risk manager with COPIC, joins us for this episode to talk about the benefits of using informed consent in your medical practice. Anna highlights how informed consent is a process (not just a form), the goals of shared decision making that guide this, and how it can be a tool to foster trust and understanding with patients. In addition, we look at what situations require informed consent and key considerations in how you approach the process. Anna also explains what informed refusal is, how this differs from “against medical advice,” and provides examples of when you...

This episode features COPIC Patient Safety and Risk Manager, Amanda Heinrichs, who discusses the importance of documentation—from sharing patient information with other medical team members to supporting care decisions. Amanda covers a wide breadth of documentation issues, such as limiting documentation to only facts about the case, moving past finger-pointing in the event of an undesirable outcome, and timely documentation to ensure quality of care. Furthermore, she talks about insights from attorneys, the pros and cons of using scribes, and conducting assessments to evaluate what is going on with patients to support your documentation.

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COPIC Patient Safety and Risk Manager Cindy Walsh is our guest to set the record straight on medical records retention—giving us insight into ethical obligations, key considerations when referring patients or closing a practice, and the importance of having a clear records maintenance/retention policy. Furthermore, Cindy outlines how regular record audits and attention to state mandates now can prevent retention headaches in the future.

Resources mentioned in the episode:

Medical record laws overview- www.HealthIT.gov

HIPAA- www.HHS.gov

Record retention ethics- https://www.ama-assn.org/

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Dr. Susan Sgambati, a colorectal surgeon and medical director with COPIC, is our guest on this episode that looks at the increased use of semaglutide medications driven by the popularity of Ozempic being used for weight loss. The discussion focuses on liability and risk issues, including recently issued FDA warning letters surrounding the use of compounded forms of the medication. Dr. Sgambati talks about how the medication works, side effects, how to assess patients who are interested in these medications, and other considerations as part of your evaluation.     

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Pamela Johnson—a nurse and Senior Manager of Practice Quality and Facilities Risk Management at COPIC—joins us for a discussion about data around patient falls in health care facilities. Pamela highlights the top three areas where falls occur in these settings and talks about top risk factors that contribute to these incidents. She also points to adjustments that can make an immediate preventative impact, such as proper lighting and pathways, the importance of environmental rounds, and dispels major myths about falls and healthcare.

CDC STEADI- Older Adult Fall Prevention https://www.cdc.gov/steadi/index...

Anna Barr, a nurse risk manager with COPIC, joins us for this episode to talk about the benefits of using informed consent in your medical practice. Anna highlights how informed consent is a process (not just a form), the goals of shared decision making that guide this, and how it can be a tool to foster trust and understanding with patients. In addition, we look at what situations require informed consent and key considerations in how you approach the process. Anna also explains what informed refusal is, how this differs from “against medical advice,” and provides examples of when you...

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes back Jennifer Disabato, DNP, and William Anderson, MD, who are co-directors for the ImPACT Program and Navigation Hub, which focuses on care coordination for complex pediatric patients as they transition to adult care. Jennifer and Dr. Anderson talk about the progress made in building skilled teams to support patients going through these transitions. In addition, they discuss the other key focus of the...

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes two staff members from West Mountain Regional Health Alliance—Christina Gair, Executive Director, and Namrata Shrestha, Assistant Director. Grant funding went toward a care coordination effort to support individuals experiencing homelessness with coordination by hospitals, health and behavioral health providers, community organizations and government agencies. The discussion looks at the challenges of coordination across multiple organizations and different workflows, consideration of factors such as...

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Dr. Matthew Gonzales and Dr. Deborah Unger who are affiliated with a grant provided to the Providence Portland Medical Foundation. Grant funding supported Providence and the Oregon Physician Orders for Life Sustaining Treatment (POLST) Registry for a partnership to build a bi-directional interface which integrates Providence's Epic electronic health record with the Registry. Dr. Gonzales and Dr. Unger discuss about how POLST is...

This episode is part of a special series that focuses on organizations that received grant funding from the COPIC Medical Foundation for initiatives that address the issue of reducing fragmentation across care settings. Dr. Zacharias welcomes Tori Bahr, MD and Katie Stangl who are affiliated with a grant provided to the Minnesota Medical Association Foundation. Grant funding supported Project ECHO, which focuses on the challenge of transitioning youth with medical complexity to adult care in Minnesota. The discussion explains the different conditions that fall under “childhood onset medical complexity” and how the ECHO hub-and-spoke model leverages virtual collaboration to expa...

Documentation in medicine is no one’s favorite topic. In this episode, host Dr. Eric Zacharias aims to simplify guidance surrounding “what” and “how much” is needed for patient safety and risk management purposes. What follows is not “hard” science, but rather a discussion of basic criteria—and what's realistic and reasonable outside of policy rules and guidelines.

Feedback or episode ideas email the show at wnlpodcast@copic.com

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate profe...

In this episode, we are joined by David Weill, MD, a transplant doctor and author of Exhale: Hope, Healing, and a Life in Transplant. Dr. Weill shares openly about losing and saving patients, dysfunctional teams and systems, and burnout in transplant medicine. Through the lens of his own emotional and physical exhaustion, he explores the underbelly of hospital systems and the clinical, administrative, and financial issues plaguing the specialty. He is an advocate of shifting the blame of burnout away from the individual and placing it on the macro problems that contribute to physician dissatisfaction. 

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We continue the conversation about artificial intelligence (AI) in this second episode of a two-part series. Our guest is Dr. Michael Victoroff, a family medicine physician, patient safety and risk management specialist, and clinical informatics expert. Dr. Victoroff uses image interpretation in radiology as an example of AI because it sees things humans miss and humans see things AI misses. We look at other AI applications—support for diagnosing and creating a treatment plan, concerns with visit notes (e.g., inaccuracies, information designed for billing purposes versus information for patient care, bias that can emerge, etc.), and the knowledge me...

In this two-part series, we look at the rise of artificial intelligence (AI) and examine the potential ways it may impact medicine. Our guest is Dr. Michael Victoroff, a family medicine physician, patient safety and risk management specialist, and clinical informatics expert who has gone down the rabbit hole of trying to understand the good, the bad, and the ugly of AI. Dr. Victoroff explains the fundamental technology behind AI applications, such as ChatGPT, and its interactive structure designed to generate human-like language and conversation. He talks about the concept of machine learning, how the “garbage in, garbage out” theo...

In this episode, we look at a major challenge in obstetrics (OB) care with our guest, Lori Adams, who is a nurse, COPIC risk manager, and OB expert. Lori talks about her experience in a rural hospital and educating providers. The discussion focuses on “maternity care deserts” where access to OB services is limited or not available. Lori highlights how these deserts contribute to maternal death rates, the disparities we are seeing in certain geographic and demographic areas, and how emergency care units are dealing with OB situations. She also points to the training and education that is being impl...

In this episode, we are joined by Dr. Shanta Zimmer, associate dean for diversity and inclusion at the University of Colorado School of Medicine. Dr. Zimmer talks about how the COVID-19 pandemic highlighted racial disparities and health care inequities in severity of illness and the role the health care system ultimately plays in systemically-addressing social determinants of health. She also speaks on how the university is working toward inclusive excellence and removing barriers that prevent the best and brightest from entering medical education. COPIC has supported diversity, equity and inclusion (DEI) scholarships for medical students and purchased simulation equipment...

In this episode, we’re joined by surgeon and COPIC risk manager, Dr. Jeff Varnell. Starting with the premise that, like driving, the practice of medicine is governed by systemic rules and dependent on individual responsibility, Dr. Varnell uses metaphors and general understandings we hold about driving to illustrate how adverse events in medicine are often avoidable and preventable, like many of our road-based accidents. He invites listeners to examine through a lens of personal accountability the human factors that lead to errors in communication and cognitive bias, including "reckless" versus "risky" behavior.  a

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With 28 million Americans at risk for limb loss due to trauma, tumors, or infections, the nonprofit Limb Preservation Foundation is enhancing the quality of life of people in the Rocky Mountain region. Executive Director Marcy Rubik joins us to talk about how health care professionals from all backgrounds have joined this effort to offset financial stressors, provide education, and advance research.

***Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation. Health care providers should...

Understanding the regulatory environment is key to managing risks associated with working with advanced practice providers (APPs), Dr. Alan Lembitz, COPIC's Chief Medical Officer says. But he cautions providers to understand this isn’t always simple. He reminds providers that it’s on them to ensure they are following the regulatory rules, which vary based on state and provider type. COPIC has seen cases of plaintiff attorneys alleging APPs practicing outside of the scope of licensure and inadequate supervision. In this episode, Dr. Lembitz breaks down high-risk areas, as well as what physicians and APPs need to know about mana...

The guest for this episode is Stephen Siegel, MD, a urologist in a multi-specialty group and a medical school classmate of our host. The former classmates discuss the impact of COVID-19 on surgical intervention, delay of diagnosis, and routine screening. They also discuss general risk areas in urology, including transitions of care, telehealth, and risks associated with PSA-level management across a patient’s lifetime.

Legal Disclaimer: 

Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that...

This episode features Dr. Alan Lembitz, Chief Medical Officer for COPIC, and focuses on uncertainty around federal and state opioid education requirements for medical providers. The conversation examines common questions from “what do I need to do to fulfill my licensure requirements?” to “how do I prove that I am in compliance with these requirements?” Dr. Lembitz also looks at details with the new DEA requirement of eight hours of training around substance use disorders, concerns if providers don’t fulfill these requirements, and highlights of COPIC resources that are available to help meet these requirements.

Informati...

This episode’s guest is Scott Humphreys, MD, forensic psychologist and medical director of the Colorado Physician Health Program (CPHP). This nonprofit independent peer assistance program provides licensed professionals with confidential, individualized evaluation and treatment referrals for health problems such as psychiatric illness and substance abuse. Dr. Humphreys discusses the stigma associated with physicians transitioning into the role of patient and the approach CPHP takes to ensure they can ultimately have a healthy practice and healthy life. 

Disclaimer: Information provided in this podcast should not be relied upon for personal, medical, legal, or financial decisions and...

Dr. Michael Victoroff, a family medicine physician and COPIC consultant with expertise in clinical informatics, is our guest for this episode that focuses on situations where patients may become violent. The discussion examines emotional states in patients, such as frustration or unhappiness, that can escalate into physical conflict and why we have seen a substantial increase in these types of encounters. Dr. Victoroff talks about de-escalation and conflict management skills, our innate flight-or-fight reactions, and the importance of appropriate training for the health care setting. In addition, the conversation explores ethical and legal considerations along with the moral dilemma...

In this episode, Dr. Jeffrey Varnell, a former surgeon and risk management consultant, reflects back on things physicians wished they would have learned during their medical residencies and when they first started their practice. In particular, he talks about effectively utilizing professional review, onboarding and managing expectations around a practice’s policies and procedures (from billing to EHRs), the importance of peer support and mentorship, and the benefits of creating a “toolkit” to help new physicians integrate into the practice setting. 

Show email: wnlpodcast@copic.com

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The episode’s guest is Chanda Hinton, the founder and executive director of the Chanda Plan Foundation, who also helps run the Chanda Center for Health, an organization that helps people living with long-term disabilities through integrative health care. The discussion focuses on looking at health care through a lens of disability and disparity, and how medical providers can help address this. Chanda talks about her organization’s belief that “people living with long-term physical disabilities have the right to create their own healthcare path, live independently, and be active members in community” and the various ways they support this ide...