What went wrong in the events that led to a medical professional liability (MPL) case is the foundation of the pursuit of compensation for damages. Tracking who is named and where the care was rendered is essential to configuring an underwriting MPL structure. However, understanding why the events that led to adverse outcome came about is the key to improving patient safety.
For MPL cases entered into CRICO’s national Comparative Benchmarking System (CBS), the answer to why is provided via a coding field called “contributing factors.” CRICO’s proprietary process captures the specific actions/inactions, systems failures, and other complicating circumstances that contributed to the event, or series of events, that triggered an allegation of substandard care. Those contributing factors reflect issues that are amenable to loss prevention and/or risk reduction strategies. And, as a coded component of each case, contributing factors constitute a data category as readily included in analytic studies as physician specialty, injury type, or any other demographic or clinical element.
Rather than being obvious, contributing factors are often pieces of a puzzle that has to be assembled from multiple sources and accounts. CRICO’s clinical coding experts have access to the medical and legal records germane to each case (including clinical expert reviews and plaintiff and defendant depositions), enabling them to comprehend the specific factors that contributed to the adverse event, the patient’s injuries, and the initiation of the claim or suit. Most cases are assigned multiple contributing factors (on average 3.3 per case). The breadth and depth of the CRICO taxonomy (more than 250 contributing factor codes), provide a unique degree of specificity.
Sample Contributing Factors in MPL Cases (2008–2017)
- Failure to establish a differential diagnosis (found in 8% of all cases)
- Misidentification of anatomical structure during surgery (2%)
- Failure to obtain consult/referral (10%)
- Policy/protocol not followed (5%)
- Insufficient documentation of clinical findings (5%)
The numbers above represent cases from all services in all settings. When those fields are narrowed to a single service, setting, or case type, then the power of contributing factors becomes even greater.
Clearly, the greatest educational value derived from MPL cases is learning why individuals or systems fell short of acceptable care and where there is opportunity for improving patient safety. The contributing factors coded into CBS cases offer an extraordinary boost to that learning process. Employing these evidence-based indicators of specific vulnerabilities as the impetus for changing systems and practice is key to truly applying the lessons learned from previous mistakes.