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An Inadequate Patient Assessment Increases the Risk of a Malpractice Defendant Being Held Responsible

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An Inadequate Patient Assessment Increases the Risk of a Malpractice Defendant Being Held Responsible

By Jock Hoffman, Jillian Skillings, CRICO

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

The odds of an MPL case closing with an indemnity payment increase 85% when the patient assessment was incomplete or otherwise inadequate.p2pspspolicy

According to analysis of 15,927 patient assessment cases from CRICO’s national comparative benchmarking system, 47% closed with payment (compared with 30% for all MPL cases). The average payment was $519,000; six percent of cases closed for a million dollars or more. Surgical and medical specialties were equally exposed; more than half (56%) involved a high-severity injury or patient death.

Half (53%) of these cases were complicated by a suboptimal response to the patient’s clinical signs or symptoms; 36% were undermined by the clinician’s narrow diagnostic focus, and a third hinged on a failure to order a clinically indicated test. The majority of patient assessment cases stem from care in an outpatient setting: 47% in office-based care and 14% in the Emergency Department.

Assessment errors are at the root of a high proportion of high-impact adverse events because they frequently lead to subsequent missed opportunities to course correct the patient’s care. When an adverse event resulting in a high-severity injury or death is linked to critical information that was missing or misleading, the likelihood of a case closing with indemnity payment increases.

Key considerations for interventions to reduce this risk include:

  • Review the role of the history and physical
  • Aid in the creation of a concise patient summary/profile 
  • Review the role of decision support tools
  • Consider the role of all team members during the assessment process
  • Be sensitive to the impact of time constraints
  • Guide a manageable differential diagnosis list 
  • Promote smarter testing
  • Address operational/environmental factors that may narrow the assessment process

To better understand your organization’s specific policy/protocol vulnerabilities, consider:

  • Which missed diagnoses are most problematic?
  • Which category of tests are most commonly not ordered/delayed?
  • Which specialty consults/referrals are most commonly delayed?

Also included in the full report, The Power to Predict, are strategies for defendingMPL cases with inadequate patient assessments.

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August 27, 2020
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