Within Normal Limits: Navigating Medical Risks

This episode features Brian Dwinnell, Associate Dean of Student Life at the University of Colorado School of Medicine, who shares his insights on medical school admissions, student support, and curriculum changes. The discussion touches on the competitive application process, the school’s holistic review philosophy, and how the new systems-based curriculum known as “Trek” is designed to better prepare and support students. The episode also covers trends in residency matching and dispels common myths about medical school, ending with an optimistic outlook on the next generation of physicians.

This episode’s guest is Dr. Mark Earnest, Division Head of Internal Medicine at the University of Colorado Anschutz Medical School. The conversation centers on the concepts of psychological size and psychological safety in medicine. Psychological size is described as a relational dynamic involving power and status within professional interactions. Psychological safety refers to creating an environment where people feel comfortable having open, honest conversations. Dr. Earnest shares stories that illustrate these concepts in the healthcare setting and emphasizes how leaders must be proactive in recognizing and managing power dynamics. In addition, he highlights the benefits of early education, how ongoing modeling of positive behaviors are essential, and that organizational culture set by leadership has measurable impacts on outcomes, satisfaction, and risk.

In this episode, we talk with Heidi Baskfield, the founder of Speak Our Minds, an organization dedicated to addressing the youth mental health crisis in the United States. Baskfield talks about her journey from political advocacy to health leadership and the committed effort required to transform youth mental health care. Their conversation explores the overwhelming mental health needs of children and the insufficiency of existing resources, which led to the declaration of a state of emergency in Colorado regarding youth mental health. Baskfield outlies four principle aims that Speak Our Minds is focused on: building robust systems of care, bolstering prevention and early intervention, addressing disproportionate impact in communities, and supporting the mental health workforce.

This episode’s guest is Dr. Josina Romero O'Connell, Director of the Colorado Area Health Education Center (AHEC). Dr. Romero O'Connell highlights AHEC’s mission to improve healthcare access and education in rural and underserved areas of Colorado. She talks about AHEC’s focus to address workforce diversity, equitable provider distribution, and practice transformation by supporting students in rural clerkships, providing continuing education, and offering community health education events. Dr. Romero O'Connell also highlights how challenges in rural healthcare such as health center closures and obstetrics deserts are being addressed by fostering community integration for healthcare providers to improve retention. In addition, the discussion covers the HOPE program, which is designed to get high school students interested in healthcare careers; and the AHEC Scholars Program, which provides learners of all ages with experiential hours and educational modules focused on underserved care.

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, appropriate ways to handle transfer of prescriptions, and continuing education to prevent mistakes.

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 and abortion, providing guidance on how healthcare providers can navigate these complex legal areas.

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.

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.

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 transfer and signs an informed refusal or against medical advice form.

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 this includes being proactive, collaborative, and mindful as a team.

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.

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.