Individual accountability in collaborative care settings
In a team-based approach, each health-care professional plays a defined role on the team. The delivery of safe health care, therefore, has become dependent on team members’ competently fulfilling their individual responsibilities, including effectively communicating with other team members.
Further, team members are expected to bring, within their scope of practice, the relevant professional knowledge and skills to the provision of care. As a result, the team-based approach to patient care has generally led to greater individual accountability.
Historically, Canadian courts placed primary responsibility for a patient’s care on the physician. Over time, with the evolution of the collaborative approach to care, the courts then began to assess whether health-care professionals complied with the applicable standard of care in light of these new principles. One of the first cases in which this became apparent was a 1996 decision in which an Ontario court found two obstetrical nurses negligent, following allegations that they failed to properly address decelerations in the fetal heart rate. The hospital argued that injury to the child would have been prevented had the physician conducted his own assessment of fetal well-being. The court stated that physicians must be able to rely on the accuracy of information provided by nurses and are entitled to assume that nurses are performing their duties competently within their scope of practice. The court noted that, unless they have reason to doubt the accuracy of the information, it is unreasonable to expect physicians to double-check nurses’ findings, as this would lead to a breakdown of the health-care system. This decision recognizes that each professional on the health-care team is responsible and accountable for the care they provide.
Recent cases continue to assess nursing care in accordance with this collaborative care model. In a British Columbia case, the court considered whether a registered psychiatric nurse was responsible for damages suffered by a patient who attempted suicide a week after his discharge from the emergency department. The hospital in that case had implemented a collaborative care protocol in which the nurse was responsible for performing the initial psychiatric assessment and collecting any relevant collateral information for patients presenting mental health issues. The nurse was then expected to convey this information to the emergency physician before the physician assessed the patient.
The court concluded that the nurse did not meet her duty to collect collateral information about the patient and communicate it to the emergency physician. The family had expressed concerns regarding the patient’s behaviour and delusional thoughts. The nurse did not convey this information to the emergency physician, who testified at trial that it would have altered her diagnosis and treatment plan. On appeal, the Court determined that the emergency physician was not at fault, as she was entitled to rely on the nurse to competently perform her initial psychiatric assessment and inform her of any relevant collateral information.
In rendering its decision, the Court of Appeal stated that each health-care professional has a duty to communicate diligently with team members to ensure that patients do not slip through the cracks. Nurses, in particular, are generally expected to collect and share relevant information obtained during their assessments, taking into account the nature of the patient’s condition and the urgency of the intervention required. This includes providing accurate and reliable charting to facilitate communication between members of the team and avoid the loss of patient information. It is also important to note that nurses may at times be obliged to escalate their concerns to ensure that the patient receives adequate and timely care.
When patient care is shared across an interprofessional health-care team, nurses should not assume that fault will fall solely or primarily on the health-care practitioner designated as the most responsible professional, in the event a patient is harmed during the provision of care.
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Disclaimer: This article is for information purposes only. Nothing in it should be construed as legal advice from any lawyer, contributor or the CNPS. Readers should consult legal counsel for specific advice.