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Spotting Risk

By Jock Hoffman, CRICO

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

A recent New Yorker article by Dr. Atul Gawande addresses the “hot spotting” phenomena by which health care providers identify locations, case types, or even individuals who account for an extreme disproportion of health care resources. Gawande indicates that these hot spot patients can often be channeled toward more coordinated care, better health, and a significant reduction in care costs.

In the patient safety arena, the hot spotting premise is already common practice for reducing the risk of preventable adverse events. For years, a reliable methodology for adroitly directing finite patient safety resources has been to identify and address the precise points in the care process where patients and providers are most vulnerable to error, harm, and litigation. And then apply proven remedies where they will do the most good.

Drilling down to a particular specialty or location or case type brings those working to effect change as close to the cause of medical errors as is possible. Solutions narrowly applied to the root causes of an organization's most egregious risks are more likely to prove effective than are initiatives painted broadly across the entire organization. But for organizations, or the head of a department of service, knowing where to start—where to place the drill—is a challenge. Sometimes, in order to understand the local issues, you need the global view.

Aided by its CBS database of more than 30,000 deeply coded medical malpractice cases from more than 400 U.S. health care institutions, CRICO has a unique big picture perspective. CRICO’s national data identifies who gets sued most frequently, for what reasons, for what types of injuries, from what patient care settings, and many other starting points from which health care leaders can begin their own risk investigation.

For example, a malpractice overview based on a CBS study of 8,057 malpractice cases asserted from 2005-2009 found that:

44%   of cases involve significant permanent injuries,
or death
48%   of cases stem from outpatient care
what the patient—or family, or estate—states as the cause
of the injury
22%   of cases allege diagnostic errors
(i.e., delayed or missed diagnosis)
21%   of cases allege surgery-related errors
(including pre-, intra-, and post-operative care)
7%   of cases allege an obstetrical care error
dollars reserved for open cases or paid for closed cases
30%   of losses stem from diagnosis-related cases
19%   of losses stem from surgery-related cases
19%   of losses stem from obstetrics-related cases
66%   of diagnoses-related cases involved errors related to ordering diagnostic tests
50%   of diagnoses-related cases involved errors related to the history and physical
36%   of surgery-related cases involved technical performance errors
17%   of surgery-related cases involved selection or management of the surgical procedure
66%   of obstetrics-related cases involved errors related to clinical judgment during labor and delivery
22%   of obstetrics-related cases involved errors related to communication among providers

Diagnosis, surgery, and obstetrics account for half of all malpractice cases and two-thirds of the financial losses. If your organization is not focusing the majority of its patient safety resources on reducing the risk of patient injury in these areas of care—for both inpatients and outpatients—it may be time to more closely examine your hot spots.

February 1, 2011
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