Every profession comes with inherent risks, and physical therapy is no exception. As a physical therapist, the very nature of what makes your job so rewarding — helping patients who are injured or in an otherwise vulnerable state — also poses some pretty serious potential liabilities.
Enter risk management, a topic that deserves much more than just a cursory glance for both new and seasoned PTs alike — especially considering the current era of rising malpractice claims. But before we cover the most common accidents that occur in PT clinics and how you can safeguard against them, let’s first take a look at the question: What, exactly, is risk management?
What Is Risk Management?
Most of us are familiar with Murphy’s law: “If something can go wrong, it will.” The field of risk management recognizes the wisdom of this adage and aims to mitigate risk by enabling professionals to identify potential hazards and stay one step ahead.
Simply put, being aware of potential risks helps to ensure the safest possible outcomes for both PTs and their patients. Lisa Folden, PT, DPT, a North Carolina-based PT and owner of Healthy Phit Physical Therapy & Wellness Consultants, says risk management isn’t just a “buzzword” — it’s a real-world concept that can make or break your professional integrity (and bottom line) as a PT.
“At its core, risk management is about being proactive rather than reactive,” Folden says. “The goal is to reduce the likelihood that something horrible will happen to your patients, yourself, or your practice. To truly provide high-quality care in a safe environment, it’s essential for best practices in risk management to be top of mind for PTs.”
There’s another reason to take note of risk management, too: Since the early 1990s, there’s been a slow but steady increase in malpractice claims made against PTs. That said, Jamie Childs Everett, PT, DPT, a Wyoming-based PT and owner of Physio Sport & Spine, believes that this news isn’t necessarily 100-percent negative. Why? As a result of this trend, Everett says that she’s witnessed a growing industry-wide emphasis on safety. For example, she’s noticed that more and more PTs are using equipment like lift mechanisms and high-to-low tables that can help reduce the risk of injury to patients and staff. As Everett points out, this is significant because when she first started her career, these kinds of measures weren’t focused on nearly as much.
What Kinds of Risks Do I Need to Look Out for in My Practice?
For PTs, there are two types of risks to watch out for:
- Risks to your patients
- Risks to yourself and/or your employees
The 3 Most Common Risks to Your Patients
Here are the three most common risks to patients that should be on your radar.
Risk #1: Improper Treatment
There are a number of claims made against PTs that fall under the “improper treatment” umbrella. This involves injury to the patient, which can stem from a number of issues:
- Poor or improper technique
- Lack of communication
- Overly aggressive force
- Improper application of ice or heat
- Overextending limbs/joints during stretching exercises
It could also include the failure to modify a treatment plan according to the patient’s physical needs or limitations.
Risk #2: Equipment Hazards
There are a few potential risks for patients when it comes to equipment, such as not being taught proper usage or technique, inappropriate use of unapproved equipment, or broken/faulty equipment.
Risk #3: HIPAA Violations
For HIPAA-covered entities, non-compliance can have serious implications. If your practice collects, shares, and uses patients’ protected health information (PHI), you’re legally required to comply with the HIPAA Rules for protecting the privacy and security of that information. If your patients’ PHI is disclosed or exposed to anyone who isn’t directly involved in their care, you could receive hefty financial and legal repercussions as a result, not to mention a loss of your patients’ trust.
The 3 Most Common Risks to Your Employees
Here are the three most common occupational hazards that PTs face on a day-to-day basis.
Risk #1: Physical Injury
PTs run the risk of sustaining injuries in a number of ways. After all, you’re working in a setting where you’re often helping people with poor balance. The parts of the body that PTs are most prone to injuring include the lower back, neck, shoulders, hands, and wrists. PTs who perform manual therapy are especially vulnerable to injury, due to the repetitive nature of their job.
Risk #2: Psychological Strain
Though PTs are focused on helping patients with physical issues, many of the people they work with are also dealing with considerable emotional and psychological issues, too. Getting emotionally invested or overly involved in your patients’ lives — coupled with the unavoidable fact that some just won’t get better in your care, despite your best efforts — can take its toll. Emotional exhaustion and high levels of stress can negatively affect PTs and even sabotage their job performance in some cases.
Risk #3: Workplace Violence
Unfortunately, it’s no secret that healthcare professionals are particularly vulnerable to physical assault in the workplace. A 2013 study revealed that 95 percent of PTs had experienced at least one incident of physical or non-physical violence committed against them in the past 12 months. The most common physical incident was being pushed, grabbed, or shoved, while the most common act of nonphysical violence was being yelled or sworn at. On top of all this, in 2017, researchers surveyed almost 900 PTs and discovered that more than 80 percent of them had experienced some form of sexual harassment from patients (e.g., sexual remarks, indecent exposure, full-blown sexual assault) during their careers, and about half of them had been assaulted in the previous year alone.
Top 9 Risk Reduction Strategies for Your Physical Therapy Practice
Now that you’re aware of the potential risks lurking in your practice, let’s talk about what you can do to help increase the safety of your patients and staff. We asked our industry experts to share their suggestions for risk-reduction strategies PTs can consider implementing in their own practices; here are the top nine they came up with.
1) Encourage better communication in your practice.
John (Jack) Hickey, a Miami-based attorney, says that strong communication skills are key to nipping potential catastrophes in the bud. He encourages PTs to embrace the abbreviation CCR: Clear, concise, and repetitive.
“Physical therapists can’t afford to be meek or soft-spoken, or to be afraid of repeating themselves,” Hickey says.
Everett also echoes the need for strengthened lines of communication between PTs and their patients. She encourages her colleagues to explain why their instructions are prescriptive, just like a medication would be, and in language that the patient can grasp (i.e., avoid overly complex medical terminology).
“There’s intent and purpose to every load, repetition, or exercise, and it’s up to you as a professional to emphasize that so that patients fully understand,” Everett says. “Always obtain consent and outline the anticipated benefits, risks, and how a treatment should feel. Practice active listening skills to ensure that you’re on the same page.”
2) Establish and enforce proper documentation protocol.
Communication isn’t just limited to the verbal sense: Written communications also must be professional and concise. Hickey says that being consistent and vigilant about documentation goes “a long way” toward protecting PTs and can be a practice’s best defense in the event a claim does arise.
Hickey also emphasizes the fact that standard documentation protocols must be established and adhered to, which includes keeping detailed records of every patient interaction. These documentations should be timely, legible, accurate, specific, and 100-percent objective. If you do forget to document something, it’s essential to acknowledge in writing that it’s a late entry. (Although, this is never appropriate to do if a lawsuit has already been initiated, of course.)
3) Stick to your scope of practice.
All three of our experts agree that staying within your scope of practice, as spelled out by your state licensing authority, is another non-negotiable aspect of risk management. Re-reading the fine print on a bi-annual basis is a good way to keep these regulations top of mind. If a service is requested that’s outside of your legal, professional, and personal scope, it’s important to notify higher-ups about the situation. Or, if you’re the supervisor or owner of the practice, your employees must be crystal clear on what they are and are not allowed to do.
4) Follow proper care protocols.
For each type of therapeutic activity or treatment, care protocols must be established and followed, says Hickey. Additionally, policies and procedures should be available to all employees at all times.
5) Routinely test equipment.
Any equipment your practice uses should be frequently tested and monitored to ensure optimal functioning. This also includes checking and documenting the temperatures of items like hot-pack warmers, paraffin tanks, and whirlpool water on a regular basis. Signage is also key, and all equipment should display clear instructions for use. To minimize the risk of a patient getting injured, PT clinics should thoroughly evaluate the placement of equipment and furniture, and closely supervise patients when moving throughout the facility.
6) Maintain professional boundaries.
The patient-therapist relationship is a delicate balance, and Folden cautions PTs to maintain professional limits.
“PTs need to stay cognizant of the hazards of letting a patient become a friend,” Folden says. “To give patients the quality of care they deserve, you need to treat them objectively and keep up a professional barrier.”
7) Closely supervise patients during treatments.
When it comes to hot packs, ice packs, electrotherapy, whirlpool, and paraffin, it’s essential to first identify the potential hazards that can arise in order to mitigate those risks. Encourage patients to communicate any concerns or questions they may have, and supervise them closely throughout the course of treatment. (Skin checks are particularly crucial.) Beyond maintaining a close watch, PTs should also keep thorough documentation regarding a patient’s status before, during, and after treatment.
8) Educate employees about HIPAA compliance.
For HIPAA-covered clinics, compliance is non-negotiable for a successful practice, which means every employee needs to be up-to-date on protocol and any changes to the law. It’s also essential to assess technological and in-building risks and to update policies accordingly so that you can better protect sensitive patient information.
“In smaller practices, it’s especially vital to be on top of HIPAA compliance, since there’s usually not the same checks and balances in place as a larger system,” says Everett. “Confidential information needs to be safeguarded.”
9) Report any claims immediately.
If a claim does arise — or an incident occurs that could lead to a claim — your insurance provider needs to be notified about the situation as soon as possible. Relaying these details in real time is critical to ensuring the best possible outcome.
Despite how overwhelming this may all seem, at the end of the day, risk management is actually about enhancing your peace of mind and professional integrity. Taking stock of common hazards in your PT practice — and taking proactive steps toward safeguarding against them — will help pave the way for your team to provide patients with high-quality care in an environment that’s safe for everyone involved.