Making the most of an unprecedented level of data access, The Doctors Company — the country’s largest physician-owned medical malpractice insurer with almost 80,000 members — has assembled a series of patient safety reports, examining and evaluating the most common closed claims across the spectrum of physician specialties.
The patient safety data comes from thousands of studies of closed medical malpractice claims across the United States, spanning virtually all physician specialties, and was assembled by the company’s experts to “alert physicians to the most common risks” in their respective specialties.
The result is a series of reports that offer “industry-leading patient safety initiatives that protect our members and their patients” by identifying and defending against “underlying vulnerabilities” in each area of practice.
As a partner with The Doctors Company — with whom we offer free CME courses to our network of locum doctors, dentists, nurses and clinicians — Staff Care’s team of recruiters has exclusive access to these in-depth patient safety studies, giving us the power to share best practices — and to impart the confidence of knowing one’s vulnerabilities and having a ready defense against malpractice claims.
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Below you'll find a brief recap of some key patient safety data takeaways; for more information on what this information means for you, please contact a Staff Care representative.
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Patient Safety Reports Share Common Themes
When examining closed claim cases in emergency medicine, hospital medicine and internal medicine, the most striking takeaway is that they all share a common area of frequent patient safety allegations — namely, diagnosis.
In emergency medicine, this complaint — "failure, delay or wrong diagnosis" — by far led the field, with 57 percent of claims highlighting this complaint. In internal medicine, diagnosis made up 39% of the claims, and in hospital medicine, 36%.
The conditions that were most often misdiagnosed in emergency medicine “included acute cerebral vascular accident and myocardial infarction (MI), spinal epidural abscess, pulmonary embolism, necrotizing fasciitis, meningitis, torsion of the testis, subarachnoid hemorrhage, septicemia, lung cancer, fractures, and appendicitis," the report states.
What brings about these claims? "Physician reviewers noted that clinicians sometimes failed to establish a differential diagnosis or to use clinical information that was available to them that should have prompted further investigation,” the report authors note. “This resulted in a failure to address abnormal findings and order diagnostic tests.”
In internal medicine, the issue of diagnosis was again the most sensitive area of patient safety. In 56% of these claims were found “inadequate patient assessments, which contributed to patient injury."
With hospital medicine, the authors admit that they’re confronting a specialty with perhaps more gray areas than the others, with patient safety best practices often a bit more difficult to identify.
"Claims arising from hospitalist care are more likely to have a higher injury severity than other physician specialties,” the authors note. “Hospitalists manage high-acuity patients, have limited access to patients’ past medical histories, and often receive patients with serious conditions. These situations require thorough assessments, comprehensive testing, quick diagnoses, timely referrals, and rapid initiation of treatment."
Similarly, in obstetrics, many cases “reflect unusual maternal or neonatal conditions that can be diagnosed only with vigilance," the authors add.
"Obstetric departments must plan for clinical emergencies by developing and maintaining physician and staff competencies through mock drills and simulations that reduce the likelihood of injuries to mothers and their infants."
Issues with diagnosis were also at the heart of closed claims studies in anesthesia, where, although “reviewers agreed that technical performance was a major factor contributing to patient harm,” they also “viewed these technical issues as being mostly known complications (80 percent) — complications the patient was aware of before the procedure — and not due to negligence."
In orthopedics, the authors go further in their patient safety recommendations, stressing “the importance of helping patients understand the information provided during the informed consent process,” as well as “the importance of engaging the patient and family when a complication occurs to show empathy and to explain what caused the undesirable result.
“This conversation also enables the physician to link the patient’s experience to information provided during the informed consent discussion,” the authors adds. “Although the patient may continue to be unhappy with the outcome of care, a patient who feels engaged in his or her care and treatment may be less inclined to attribute the outcome to negligence or to bring a liability claim against the physician.”
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“Physician experts for both the plaintiffs/patients and the defendants/physicians reviewed claims and conducted medical record reviews,” the company notes. “We then looked at patients' injuries to understand the full scope of harm."
The report authors note that “It is hoped that these insights will lead to system and process improvements that contribute to patient safety,” with “a broader overview of the system failures and processes that resulted in patient harm.”
The data also provides a solid foundation for malpractice defense for doctors and the practices that employ them. “When a member's reputation and livelihood are attached, insights gained from these studies help us provide the most aggressive defense in the industry,” the authors note.
And we’re fully on board with that! We’re happy to offer the doctors in our network more insight into these innovations in patient safety standards. Simply contact us today and we’ll be happy to fill in the blanks.
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For more data of this nature, including a comprehensive suite of online resources that features a self-paced interactive guide, visit The Doctors Company website.