The Florida Patient Safety and Presuit Mediation Program (FLPSMP) is a mandatory mediation program designed to provide deserving patients with fast, fair compensation while limiting the healthcare provider expenses incurred during traditional litigation. Mediation occurs before litigation begins; therefore, patients with meritorious claims receive compensation often years earlier than they would with extended litigation. This early mediation fosters confidential and candid communication between doctors and patients, which promotes early fact-finding and candid discussion. The program went into effect across the University of Florida (UF) Health system on January 1, 2008. In an article previously published in this journal, we discussed the positive trend observed 2 years after the implementation of the FLPSMP. This article incorporates 5 years of data, which includes new benchmarks with state and national data, to demonstrate that the program can be used successfully as a medical malpractice solution.

Introduction Mental health specialists (MHS, or 68X) play a central role in meeting the growing demand for combat stress care among Service Members. Partnering with civilian institutions may enhance the MHS training experience beyond Advanced Individual Training (AIT). Methods We describe a novel military–civilian collaboration to train U.S. Army Reserve MHS’s in the psychiatric emergency service (PES) of a public, safety-net hospital. Details of implementation are described. The training rotation was evaluated after 1 year through a comprehensive chart abstraction of patients seen as well as surveys of MHS’s and civilian partners. Results The roles of MHS and physician officers in this rotation are described. Over 9 days in the PES, the MHS team evaluated 26 patients. MHS’s described a high-quality training environment (83% rated very good or excellent) in which they frequently saw high-risk patients relevant to military practice. Experience with a certain patient presentation was correlated with comfort assessing and managing that presentation (p < 0.01). Many civilian staff (40%) felt the PES operated better with the presence of the Army team and 50% of civilians agreed their impression of the U.S. Army Reserve improved as a result of the partnership. Hundred percent of specialists and 80% of civilians reported very good to excellent rapport between military and civilian staff. Two civilian respondents (11%) expressed concern that the military team’s presence impeded patient care. Conclusion This is the first military–civilian training collaboration for behavioral health specialists, who have already completed AIT. This program provided well-received and mission-relevant training for MHS’s without notable adverse effects on patient care or team functioning in a civilian environment. Our findings are based on a small sample size, and no other such programs exist against which to compare these results. We propose that such educational partnerships, which have long been effective for other clinical specialists, may benefit the military, civilian communities, and the country.

Limited data exist regarding rehabilitation medicine consultation services in the acute-care hospital setting. We examined implementation rates of rehabilitation consultant recommendations in a university hospital with either a rotating physician service or a single advanced-practice nurse. We performed a retrospective chart review of all patients evaluated by a rehabilitation consultation service for 2 months at a single 300-bed hospital: The first month with rotating physicians (MP) and the second month with a single advanced-practice nurse (SP). Total consultations/recommendations were similar during the 2 months (MP-63/251, SP-68/240, respectively). The overall implementation rate was greater during the month with the SP (SP-74%, MP-47%), although implementation was similar for discharge disposition (MP-82%, SP-85%). In this university hospital, rehabilitation consultation recommendations were more frequently implemented with a single-provider consultation service. Further study of rehabilitation consultation services is needed, including evaluation of nonphysician consultants.