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Policy/Protocol Missteps More Likely to Result in Paid Claims

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Policy/Protocol Missteps More Likely to Result in Paid Claims

By Jock Hoffman, Jillian Skillings, CRICO

Related to: Claims, Clinical Guidelines, Communication, Diagnosis, Documentation, Nursing, Patient Safety Awareness, Publications

The odds of a medical professional liability (MPL) case closing with an indemnity payment increase 145% when the involved organization lacked a formal policy or protocol related to patient care, or an existing policy/protocol was not followed by the patient’s care providers.p2pspspolicy

According to analysis of 2,723 policy/protocol cases, 63% closed with payment (compared with 30% for all MPL cases). The average payment was $367,000; six percent of cases closed for a million dollars or more. Nursing (36%) was the most common responsible service and 44% involved high-severity injuries.

Two-thirds of these cases were complicated by a caregiver unaware of or failing to follow existing policies/protocols (34% cited the absence of an appropriate policy). Often, these failure-to-follow events reflect inadequate staffing, a lack of training, or a practice culture inappropriately tolerant of workarounds or loose compliance. Patient falls were the most common case type.

Formal policy/protocol issues might not be noted in the medical records, but such gaps become apparent to analysts trying to understand certain acts or omissions within a case narrative (and direct reference may be found within expert opinions, depositions, or trial testimony). Because adverse events in this category often point to deviation from formal protocols (i.e., acts of volition vs. oblivion), plaintiffs with obvious damages can draw a line to causation.

Key considerations for interventions to reduce this risk include:

  • Establish who is accountable for training
  • Determine if breaches are due to the policy’s purpose or the associated tasks
  • Include all relevant staff in the solution
  • Routinely address failures to follow established policies
  • Evaluate trends and inconsistencies to identify where a policy to unify diverse behavior is needed
  • Focus on policies germane to high-risk consequences
  • Engage all impacted disciplines in the process of development and periodic review
  • Evaluate the notification, implementation, and monitoring processes
  • Consider the downstream impact of introducing a new policy

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

  • Are we more susceptible to policy absences or violations?
  • Where do we see the most significant injuries/losses?
  • Are certain services or settings frequently cited for policy violations?

Also included in the full report, The Power to Predict, are strategies for defending MPL cases involving policy or protocol gaps or violations.

Additional Materials


July 28, 2020
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