A survey of more than 4,000 U.S. primary-care physicians found that 59% had been named in at least one malpractice lawsuit in their career. Obstetricians, gynecologists and surgeons were the specialists most likely to be sued, according to findings published in Medscape Wednesday.
The survey also found nearly one-third of the lawsuits were the result of inaccurate diagnoses. Another third came from patients who suffered abnormal injuries while receiving treatment.
The findings seem consistent with concerns recently raised by other patient-safety advocates regarding the obstetricians' overuse of cesarean-section procedures, surgical inefficiencies and a limited focus on diagnostic errors.
For example, operating-room care-delivery processes have been called “remarkably chaotic” and recent studies suggest OR inefficiencies pose patient-safety risks. Some health systems have been working to streamline their OR processes to improve efficiency and patient care.
In September, the National Academy of Medicine released a report on diagnostic errors that estimated about 5% of outpatients experience a diagnostic error each year, and that 1 out of 10 patient deaths from medical errors may be related to diagnostic oversights. The academy and others suggested that hospitals and health systems use computer-assisted diagnosis technology, which helps clinicians generate lists of potential diagnoses.
Those issues were also the focus of sessions at the Institute of Healthcare Improvement's annual forum this week in Orlando, Fla. Attendees were encouraged to look more closely at medical-malpractice claims to identify areas for quality improvement.
One session focused on improvement efforts of the Hospitals Insurance Co. That malpractice insurer, which represents 14 hospitals around New York City, looked at its most frequent claims and found 37% were related to surgery. That led to the launch of a surgical safety collaboration among four of its clients in 2011. As part of the initiative, they standardized patients' pre-operative medical assessments.
The Montefiore Medical Center participated in the collaboration, and its safety leaders were surprised to find that in 40% of cases, assessments that cleared patients for surgery did not list their comorbidities and other factors that could impact outcomes.
“It's probably an overestimation, because we gave credit to even minimal information in the chart,” said Dr. Calie Santana, the hospital's associate director of quality who presented findings at the IHI conference. The hospital made filling out the assessment a “hard stop,” she said. “You could not go into the OR if it hadn't been completed.”
The project focused on that process, and the facility is now starting to measure its impact on surgical outcomes. Hospitals Insurance said it would be difficult to know whether the protocols led to fewer malpractice lawsuits, but that improving processes generally has a positive impact on patient care.
Another session on the issue of diagnostic errors included presentations by Dr. Gordon Schiff, director of clinical quality research at Brigham and Women's Hospital in Boston and Dana Siegal, director of patient safety for CRICO Strategies, the malpractice insurer for all the Harvard Hospitals.
According to CRICO data, surgery-related allegations accounted for the greatest number of malpractice cases among the insurers' hospitals between 2009 and 2013. However diagnosis-related errors were the most expensive. Siegal suggested providers change the way they look at malpractice data by using it to identify problems and find solutions.
That sentiment is shared by Dr. Sandeep Mangalmurti, a cardiologist at Bassett Medical Center in Cooperstown, N.Y. In a recent phone call with Modern Healthcare, he said his practice tracks “danger zones” through its Cardiology Medical Malpractice Registry. This helps providers identify when they need to be more communicative with patients or more careful about documentation.
Slightly more than 40% of the respondents in the Medscape survey reported that their case had been dismissed, and for 32%, a settlement was reached before trial. Dismissed cases can also be educational, Mangalmurti said.
“If it has risen to the level of involving the insurance company, it's more than just a trivial claim,” he said. “As providers, we have to recognize that, for whatever reason, these scenarios are associated with lawsuits and in those scenarios our antenna needs to be up.”