Avoiding Credentialing Hazards

Malpractice insurers and specialty boards try to help hospitals protect patients and providers from bad actors. Resource, May 2006.

Best Practice: Supervision in the Office Practice

Structure is the key to showing good oversight. Resource, May 2006.

Claim Experience for Residents and Fellows

Twenty-four percent of CRICO claims since 1995 named residents and fellows. Those claims represent 14 percent of the total dollars incurred in that time period. Residents and fellows make up about 21 percent of all physician defendants named; a third of the time, no attending physician is named.

Do the Claims Hold Up?

A Study of Medical Negligence Claims Against Neurologists

This paper presents a review of 42 closed medical malpractice claims filed in the past 20 years against neurologist defendants covered by a common insurer. Several studies have investigated whether medical negligence claims yield merited outcomes. The authors sought to expand this body of knowledge by studying a series of claims against neurologists.

Executive Walk Rounds in Ambulatory Sites

A technique for using senior hospital executives to improve patient safety is proving so successful that one hospital in Boston is now applying it to ambulatory sites.

Executive "walk rounds" is the name given to the practice, which Brigham & Women's Hospital in Boston started several years ago for inpatient units. The CEO, chief financial officer, and the heads of nursing or medicine visit the front lines routinely with patient safety officers to learn from providers about ongoing threats to safety.

Knowing the Limits of Expertise

In keeping with a major objective of the conference to bring in outside perspectives—and ideas from outside traditional thinking in medicine—two best-selling authors and contributors to The New Yorker magazine spoke on the nature of imperfection.

Dr. Atul Gawande is Assistant Director for the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston. He is also a regular columnist for the New England Journal of Medicine and author of the book, “Complications: A Surgeon’s Notes on an Imperfect Science,” about the challenges at the center of modern medicine.

Dr. Gawande was joined by Malcolm Gladwell. Gladwell is author of “The Tipping Point,” about understanding social and business trends, and the more recent book “Blink,” which explores the connection of instinct to decision-making.

Legal Report: Non-physician Liability for PCP

Getting help with clinical care in the office practice means getting added duty. Resource, May 2006

OB Simulator Cuts Harvard Medmal Premium

One of the clinical specialties that stands out when it comes to professional liability is obstetrics. Nowhere do the clinical stakes and the patient's expectations seem higher. Rarely is the plaintiff in a malpractice trial more sympathetic. This is echoed in the professional liability premiums that obstetricians pay, some of the highest in the industry. In the Harvard medical system, the self-insurance program known as CRICO is pursuing a proactive role in promoting patient safety and improved outcomes. CRICO has begun offering a malpractice premium incentive discount to the OBs it insures. The discount applies if the insured physician meets six criteria, one of which is attendance at a program for team training. One of the team training programs approved by the liability insurer involves a labor & delivery simulator.

Potential Impact of Coombes v. Florio

The Coombes decision appears to extend a physician's professional liability exposure beyond his or her patients to (non-patient) third parties harmed by a patient under certain circumstances. Precisely what those circumstances are and how much a physician is obligated to do to prevent them is the crux of the present uncertainty.

Risk Management Essentials

When we say "Risk", we mean uncertainty about future events that may threaten the safety of patients and the assets and reputations of providers. Generally, assets fall into several categories.

People—patients, clinicians, boards of directors, volunteers, employees.
Property—buildings, facilities, equipment, materials, copyrights, and trademarks.
Financial—revenue, reserves, reimbursement, grants, and research.
Goodwill—health and well-being, reputation, stature in the community, and the ability to raise funds and appeal to prospective audiences.

Risks Behind Resident Work Limits

A sleepy-eyed resident physician finishing her notes after a string of 36-hour shifts; it may be an outdated image, after new work-hour limits went into effect this past July for US hospitals. Everyone hopes the new rules will lead to fewer mistakes and safer care for patients. But what are the downstream consequences? How can hospitals anticipate and manage new risks created by limiting resident work hours? Based on concerns about the impact of fatigue on human performance, the Accreditation Council for Graduate Medical Education, or ACGME, now requires the following for residents: a maximum of 24 consecutive work-hours, 10-hours rest between shifts, a limit of 80 hours per week, a minimum of one day out of seven away from the hospital, and on-call duty no more frequently than every third night.

Standards for Residents Same as Senior Physicians

Some residents, fellows, and even the physicians who supervise them may assume that physicians-in-training are held to a lower standard of care than attendings. But Legal Editor Frank Reardon discusses a new Rhode Island Supreme Court case that joins other decisions across the country holding residents to the same standard as attendings.