Telephone advice for neurosurgical referrals. Who assumes duty of care?

The rising rate of litigation against all specialities provides an incentive to develop risk management strategies. Much of a neurosurgeon's workload is telephone advice, which is rarely documented formally. This leaves us vulnerable to other clinicians' interpretation of our advice, their record of our conversation and poor accuracy of recall by both parties. We performed a prospective study of all telephone conversations with referring clinicians over 1 year, in order to assess the quality of information transfer. We found that the information received was often inaccurate, documentation of our given advice was poor, and criticism of neurosurgical care was unfounded. We have developed a proforma to be faxed back to the referring team. This will ensure that the information received, and the advice given in return, is recorded formally by both teams. Only time will tell if a joint record such as this will provide sufficient defence against litigation.