Department of Dermatology: Procedure for Discharging or Formally Warning an Abusive Patient

This procedure provides the guidelines and steps for effectively and consistently managing disruptive or abusive patients in the clinical setting. Disruptive or abusive patients can be identified either through in-person contact at UNC Dermatology sites or through phone contact with UNC Dermatology clinics.

Unit Procedure

Title

Department of Dermatology: Procedure for Discharging or Formally Warning an Abusive Patient

Introduction

Purpose

This procedure provides the guidelines and steps for effectively and consistently managing disruptive or abusive patients in the clinical setting. Disruptive or abusive patients can be identified either through in-person contact at UNC Dermatology sites or through phone contact with UNC Dermatology clinics.

Scope

This Procedure applies to all faculty, staff and residents, and includes both School of Medicine (SOM) and UNC Health Care System (UNCHCS) students and employees.

Procedure

The following guidelines and steps should be followed when addressing abusive and disruptive patient behavior:

1. At time of incident:

   1. In person contact:

      1. Safety comes first when dealing with a disruptive or abusive patient. If a patient is disruptive but non-threatening, whenever possible, inform them in the moment that their behavior is inappropriate and will not be tolerated.

      2. If the patient refuses to comply, ask them to leave the facility. If the patient refuses to leave, call UNC Police (919-962-8100) or, if an emergency situation, call 911.

      3. If patient is violent or threatening violence, secure the safety of yourself and others and call 911 immediately prior to calling UNC police.

   2. Phone contact:

      1. If patient is behaving inappropriately on the phone, inform them immediately that their behavior is inappropriate, and that the conversation will be terminated if the behavior continues.

      2. Notify the patient that they will be reported to clinic management if the behavior continues.

2. Follow up after the disruptive incident must include:

   1. Documentation of the incident in the chart in as much detail as possible, using specifics such as quotations by the patient (may use ** to address profanity). If the event occurs during the patient visit, please document directly in the progress note. If the event happens outside of the visit, information should be documented in a telephone encounter.

   2. Creation of a SAFE report describing incidents of disruptive or threatening behavior.

   3. Notification of any physician(s) involved in the patient’s care, as well as the Dermatology Leadership Group:

      1. The appropriate Patient Services Manager for the site

      2. The Administrative Support Supervisor, if the event occurred at the front desk or during scheduling

      3. The Director of Clinical Services

      4. The Chair

3. Resolution of Incident:

   1. Members of the Dermatology Leadership Group included in Section B. III will determine appropriate resolution on a case-by-case basis and may include such actions as:

      1. Warning – Sending of a formal warning letter, or

      2. Discharge - Discharging the patient from the practice. Typically, patients discharged from one provider in the Department will be discharged from the practice. This will be determined based on the specific situation.

4. Post-resolution Steps:

   1. The physician involved will contact Risk Management (Carol Douglas, carol.douglas@unchealth.unc.edu), via email only to inform them of the incident, request their review of the case, and solicit their  recommendations. Note: Do not send to Risk Management via inbasket in EPIC.

   2. The physician involved in the patient’s care will compose a letter of discharge or warning, as appropriate, which shall be reviewed by Risk Management.

      1. Risk management can provide templates for each action upon request. Templates have been converted to Epic SmartPhrases (.DERTERMINATIONLETTER and .DERWARNINGLETTER).

      2. The letter can be created in Epic, printed as a Preview (and then deleted if not yet reviewed by Risk Management).

      3. The physician involved in the patient’s care (or department leadership) may sign the letter once reviewed by Risk Management.

      4. One signed, copy should be sent by certified mail, and another copy should be scanned into the medical record.

   3. If patient is discharged, the physician will request that Director of Clinical Services and Administrative Support Supervisor block patient from scheduling further appointments. Patients have the right to seek emergent treatment from the Department for up to 30 days after the date indicated on the certified letter.

Related Requirements

Unit Policies, Standards, and Procedures 

Department of Dermatology Policy on Discharging or Formally Warning an Abusive Patient

Contact Information

Primary Contact

Name: Laura Ferris, MD, PhD - Chair

Telephone: 919-966-0785

Email: Laura_Ferris@med.unc.edu

Other Contacts 

Name: Ytina Mangum - Associate Chair for Administration 

Telephone: 984-215-5032

Email: Ytina_Mangum@med.unc.edu

Name: Paul Von Hofen, Jr., MSN, RNC-OB, CNOR - Interim Director

Telephone: 984-215-3352

Email: Paul.VonHofen@unchealth.unc.edu

Subject: Risk Management 

Name: Thomas Liu, JD, MHA - Director of Risk Management

Telephone: 984-215-3759

Email: Thomas.Liu@unchealth.unc.edu