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A Handful of Opportunities to Reduce the Risk of Being Sued

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A Handful of Opportunities to Reduce the Risk of Being Sued

By Jock Hoffman, CRICO

Related to: Claims, Patient Safety Awareness

In many lines of business, recognizing that a high percentage of outcomes are driven by a small number of factors helps strategists appropriately align resources with areas of need.

In the realm of patient safety, that rule of thumb suggests that health care leaders working to reduce the risk of medical errors may be well served to focus on a handful of opportunities for improvement.

Analysis of CRICO’s national comparative benchmarking system (CBS) shows that a large majority of malpractice allegations can be attributed to a relatively short list of missteps in technical performance, clinical judgment, or communication. For example, for each CBS case, CRICO’s clinical coding specialists code factors that contributed to the event(s) that triggered the malpractice allegation. In at least nine percent of the 53,439 CBS claims and suits asserted from 2017–2016, one or more of the five contributing factors below was identified. Combined, these factors account for 21 percent of all contributing factors coded for that set of cases.


Top Contributing Factors in MPL Cases

53,439 claims and suits asserted from 2007–2016
A case may have more than one contributing factor.

 

22% involved a possible technical problem (i.e., a known complication)

This code is assigned to cases in which the complication encountered is a known risk of the operation or procedure and (there is an expectation that) the patient was informed of this during the consent process.

Responsible Services
55% surgery

Care Setting
50% ambulatory
48% inpatient
2% emergency

Injury Severity
66% medium severity
15% high severity (excl. death)
10% death

Total Incurred Losses
17% of all losses accrue to cases involving this factor

   

 

12% involved a failure or delay in ordering a diagnostic test

This code is assigned to cases in which the correct diagnosis might have been facilitated or expedited by further analysis through (specific) diagnostic testing.

Responsible Services
26% surgery
22% general medicine

Care Setting
49% ambulatory
34% inpatient
16% emergency

Injury Severity
34% medium severity
31% high severity (excl. death)
33% death

Total Incurred Losses
22% of all losses accrue to cases involving this factor

   

 

11% involved a failure to appreciate and reconcile relevant sign/symptom/test result.

This code is assigned to cases in which the clinician(s) failed to recognize the clinical picture from the available information, including patient history, reported symptoms, physical examination, and test results.

Responsible Services
29% surgery
16% general medicine

 

Care Setting
49% inpatient
38% ambulatory
13% emergency

 

Injury Severity
31% medium severity
31% high severity (excl. death)
37% death

 

Total Incurred Losses
22% of all losses accrue to cases involving this factor

   

 

10% involved a failure or delay in obtaining a consult (or referral)

This code is assigned to cases in which the patient’s diagnosis, or an optimal treatment plan, might have been facilitated or expedited by the findings of a (specific) specialist.

Responsible Services
27% general medicine
20% surgery

 

Care Setting
50% ambulatory
35% inpatient
15% emergency

 

Injury Severity
33% medium severity
32% high severity (excl. death)
34% death

 

Total Incurred Losses
15% of all losses accrue to cases involving this factor

   

 

9% involved a breakdown in communication among providers regarding the patient’s condition

This code is assigned to cases in which two or more clinicians failed to follow through with the appropriate communication of clinical information, including across care settings.

Responsible Services
23% surgery
14% nursing

 

Care Setting

56% inpatient
32% ambulatory
12% emergency


Injury Severity
27% medium severity
28% high severity (excl. death)
42% death

Total Incurred Losses
16% of all losses accrue to cases involving this factor

 

Credible evidence about patient safety risks, especially comparative data, enables a medical practice or health care organization to pinpoint which individual and system vulnerabilities are most in need of attention and resources. And, even though common problem may require somewhat varied approaches for different specialties or settings, many of the patient safety tools and tactics can be broadly applied.

Additional Material


May 4, 2017
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