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What, Me Worry?

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What, Me Worry?

By Jock Hoffman, CRICO

Related to: Ambulatory, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Where are patients most at risk for unintended harm: the OR, the ED, the MD’s office? Whose risk of being involved in a preventable adverse event is greater: a primary caregiver, a radiologist, a neurosurgeon? Are technical errors more common or more costly than cognitive errors? What patient safety risks should you be most aware of for your particular specialty or setting? Where do you direct your attention?

A majority of physicians and nurses will not be sued for malpractice at any time during their careers and, even for those who do get named in a lawsuit or two, such personal exposure is so rare that it is highly inadequate as an indicator of the overall risks to patient safety. Even across a large health care facility (more than 100,000 annual inpatient days), spotting trends from malpractice data is inhibited by low frequency (<13 malpractice cases per year). For both individual health care providers and the organizations in which they practice, identifying what to worry about—which risks to prioritize—is often daunting.

Aggregated malpractice data, however, can help focus the picture of the vulnerabilities. The data shown below are based on 11,500 malpractice claims filed from 2005-2009 against institutions who report to the CRICO/RMF Comparative Benchmarking System.


Top Locations Cited in Malpractice Cases

sps 2010 bar chart


In-depth coding of each case further enables our understanding of what prompted the patients (or families) to file lawsuits. For example, from our study sample, we can discern the top allegations and some of the underlying issues.


Malpractice Claimant’s Top Allegations

24%   Surgery-related Error
(67% of these cases allege an error in technical skill)
24%   Improper Medical Treatment
(53% of these cases question clinical judgment)
21%   Missed or Delayed Diagnosis
(54% of these cases involve cancer diagnoses)
7%   Obstetrics-related Error
(22% of these involve hypoxia/birth asphyxia)
6%   Medication-related Error
(19% of these involve an ordering error)

Drilling down even deeper into aggregated malpractice cases can help us further form hypotheses about local risks, but fine tuning your understanding of the current risks in your own setting demands timely information specific to your practice setting. Fortunately, every health care organization collects and reports on a wide variety of patient safety-related data. If you know where to look, you most likely have a treasure trove of information within reach. Not every organization provides all of these data sources—and some may generate others not listed—but you never know until you ask your risk manager or patient safety leaders.


Important Patient Safety Data Sources [pdf]

Patient Satisfaction Survey
Pertains to recently received health care services


When you do study and cross-reference these data, you are likely to have a much clearer picture of what—if anything—you should worry about.

Additional Material


June 1, 2010
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