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Benchmarking Report Reveals ED Risks across the Country

  • July 27, 2012

CRICO Strategies’ Comparative Benchmarking System (CBS) annual report on malpractice risks in emergency medicine is available  upon request, for free.


Cambridge, MA , July 27,2012 — Emergency Medicine Malpractice allegations were cited in about four of every 100,000 Emergency Department (ED) visits in a recent study of more than 90 hospitals across the country by CRICO Strategies. Missed and delayed diagnoses—stemming from vulnerabilities throughout the process of care in the ED—were the most prevalent allegation, cited in 47 percent of the 1,304 cases that made up the study.

These findings have been published in a report entitled, “2011 Annual Benchmarking Report: Malpractice Risks in Emergency Medicine.” This landmark analytical report is based on data from malpractice cases asserted from 2006 to 2010. Those cases were mined from CRICO Strategies’ Comparative Benchmarking System (CBS), the largest of its kind in the world, containing more than 200,000 clinically coded medical malpractice claims.

Almost half of [the diagnosis-related] cases arising in the ED involved a permanent injury or death, and the average payment in an ED diagnosis-related case was $508,000.  The key drivers of missed or delayed diagnoses are: inadequate assessments, judgment errors related to ordering a test or image, communication breakdowns among team members, and un-reconciled clinical information at discharge. 

An inaccurate assessment most commonly stems from a team of providers fording multiple streams of clinical information for several patients simultaneously. Emergency Medicine physicians are the most frequently identified defendants in these cases (40%), but physician assistants and nurses are also vulnerable. The report also states that community hospital-based nurses are named twice as frequently in ED malpractice cases as are their counterparts in academic medical centers.

A typical ED malpractice case pivots on the clinicians missing a key opportunity to gather or share one more bit of knowledge.  However, the impact of failures and delays in ordering tests and consults differs based on the volume of visits: EDs with the largest volume (>75K/year) have the greatest challenge with delays in ordering diagnostic tests, while those with the smallest volume (<25K/year) have the greatest challenge with delays in ordering or obtaining consults.  In 39 percent of the ED diagnosis-related cases, a judgment error related to ordering a test or an image was noted. A mismanaged consult was a factor in 26 percent of cases.

Malpractice Risks in Emergency Medicine also notes that one out of every three ED cases has breakdowns in communication by physicians, nurses, or both, and that the ED environment with its steady distractions and disrupted communication presents challenges even to those who excel at solving diagnostic problems.  Teamwork skill training and continuous collaboration between physician and nurse leadership is critical to enhancing clinical decision-making and care coordination in the ED. 

In addition to offering a deep exploration of diagnosis-related risks in the ED, the report highlights examples of health care organizations leveraging Strategies’ coding and analytical process to develop interventions targeting their most critical risks. By combining identified risk areas with proven safety solutions, the Report provides a roadmap to organizations seeking to improve Emergency care for their patients, while reducing risks and potential financial losses.

To obtain electronic or hard copies of the report, or for more information about the origin of the data - the CBS database, and Strategies services and products, email: Gretchen Ruoff, MPH, CPHRM, or call 617.679.1312.

View all Comparative Benchmark Reports.