Lessons Learned From Medical Malpractice Claims Involving Critical Care Nurses

2020 ◽  
Vol 29 (3) ◽  
pp. 174-181
Author(s):  
Laura C. Myers ◽  
Lisa Heard ◽  
Elizabeth Mort
Keyword(s):  
Emergency Department ◽  
Operating Room ◽  
Medical Malpractice ◽  
Odds Ratio ◽  
Improve Patient Safety ◽  
Lessons Learned ◽  
National Database ◽  
Malpractice Claims ◽  
Common Diagnosis ◽  
Multivariable Regression

Background Medical malpractice data can be used to improve patient safety. Objective To describe the types of harm events involving nurses that lead to malpractice claims and to compare claims among intensive care units (ICUs), emergency departments, and operating rooms. Methods Malpractice claims closed between 2007 and 2016 were extracted from a national database. Claims with a nurse as the primary provider were identified and then compared by location of the harm event: ICU, emergency department, or operating room. Multivariable regression was used to determine predictors of claims payment. Results Of 54 699 claims, 314 involved ICU nurses as the primary provider. The majority (59%) of claims involving ICU nurses resulted in death or permanent injury. The most common allegation of claims involving ICU nurses was failure to monitor (47%), which was higher than among claims against nurses in the emergency department (9%) or the operating room (4%) (P < .001). The most common diagnosis in claims involving ICU nurses was decubitus ulcers (26%). Despite equivalent numbers of defendants per claim, the median indemnity for paid claims involving ICU nurses was higher ($125 000) than that paid for claims originating in the emergency department ($56 799) or operating room ($43 910) (P < .001). In multivariable regression, 2 variables increased the risk of claim payment: ICU location (odds ratio, 1.79 [95% CI, 1.29-2.48]) and permanent injury (odds ratio, 1.50 [95% CI, 1.07-2.09]). Conclusions Malpractice claims involving ICU nurses were distinct from claims in comparably fast-paced settings. Focusing harm-prevention efforts in the ICU on skin integrity and monitoring of patients would most likely mitigate many highly severe harms involving ICU nurses, which would benefit both patients and nurses.

Medical Malpractice Claims Involving Physicians in the Intensive Care Unit: A Cohort Study

2020 ◽  
pp. 088506662095794
Author(s):  
Laura C. Myers
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Medical Malpractice ◽  
National Database ◽  
Pulmonary Medicine ◽  
Physician Specialty ◽  
Malpractice Claims ◽  
Multivariable Regression ◽  
Medical Malpractice Claims

Background: The intensive care unit (ICU) is a fast-paced setting, in which physicians from different specialties work. The goal of this study is to understand whether characteristics of medical malpractice claims occurring in the ICU differ by physician specialty. Methods: A retrospective cohort study was performed using a national database called the Comparative Benchmarking System, which is operated by Harvard’s malpractice insurer. Claims were included if the harm events occurred in the ICU and closed between 2007-2016. Claims were analyzed according to physician specialty of the “primary responsible provider,” which was the physician most directly involved in the harm event. Patient-, provider- and claim-level characteristics were compared among the 6 most common physician specialties that were identified as “primary responsible provider.” Multivariable regression was performed to identify factors associated with claim payment. Results: Of 54,772 claims, 1,113 resulted from harm events in the ICU, of which 843 involved the following physician specialties: internal medicine (305), cardiology (163), pulmonary medicine (149), general surgery (98), neurology (97) and anesthesia (31). The minority of claims across physician specialties originated in academic medical centers (<30%). The most common severity of harm was death (Range 42-72%, P = 0.0001). The frequency with which claims involved procedures varied by physician specialty (Range 24-84%, P < 0.0001). The 3 most common contributing factors (patient assessment, selection/management of therapies and communication among providers) did not differ by physician specialty. In multivariable regression, claims that were procedure-related were statistically more likely to result in payment (Odds Ratio 2.29, 95% Confidence Interval 1.64-3.20), after adjusting for physician specialty. Conclusions: There were few unexpected differences in malpractice claims occurring in the ICU by physician specialty. Prevention efforts could focus on procedures, regardless of physician specialty, including: 1) maintaining procedural skills, 2) framing procedural risks well and 3) accurately describing procedural complications after they happen.

The application of graph theoretical analysis to complex networks in medical malpractice: Lessons learned from China (Preprint)

2021 ◽  
Author(s):  
Shengjie Dong ◽  
Chenshu Shi ◽  
Zhiying Jia ◽  
Minye Dong ◽  
Yuyin Xiao ◽  
...  
Keyword(s):  
Informed Consent ◽  
Medical Malpractice ◽  
Semantic Network ◽  
Lessons Learned ◽  
World Health ◽  
Complex Network Theory ◽  
Scale Free ◽  
Interactive Behavior ◽  
Technical Errors ◽  
Malpractice Claims

BACKGROUND Studies have shown that hospitals or physicians with multiple malpractice claims are more likely to be involved in new claims; this finding indicates that medical malpractice may be clustered by institutions. OBJECTIVE We aimed to identify common factors that contribute to developing interventions to reduce future claims and patient harm. METHODS This study implemented a null hypothesis whereby malpractice claims are random events—attributable to bad luck with random frequency. As medical malpractice is a complex issue, thus, this study applied the complex network theory, which provided the methodological support for understanding interactive behavior in medical malpractice. Specifically, this study extracted the semantic network in 6610 medical litigation records (unstructured data) obtained from a public judicial database in China; they represented the most serious cases of malpractice in the country. The medical malpractice network of China (MMNC) was presented as a knowledge graph; it employs the International Classification of Patient Safety from the World Health Organization as a reference. RESULTS We found that the MMNC was a scale-free network: the occurrence of medical malpractice in litigation cases was not random, but traceable. The results of the hub nodes revealed that orthopedics, obstetrics and gynecology, and emergency department were the three most frequent specialties that incurred malpractice; inadequate informed consent work constituted the most errors. Non-technical errors (e.g. inadequate informed consent) showed a higher centrality than technical errors. CONCLUSIONS Hospitals and medical boards could apply our approach to detect hub nodes that are likely to benefit from interventions; doing so could effectively control medical risks. CLINICALTRIAL Not applicable

Management of the Difficult Airway

2005 ◽  
Vol 103 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Gene N. Peterson ◽  
Karen B. Domino ◽  
Robert A. Caplan ◽  
Karen L. Posner ◽  
Lorri A. Lee ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Airway Management ◽  
Difficult Airway ◽  
Odds Ratio ◽  
Improve Patient Safety ◽  
Multiple Logistic Regression Analysis ◽  
Management Strategies ◽  
Difficult Airway Management ◽  
Malpractice Claims ◽  
Time Periods

Background The purpose of this study was to identify the patterns of liability associated with malpractice claims arising from management of the difficult airway. Methods Using the American Society of Anesthesiologists Closed Claims database, the authors examined 179 claims for difficult airway management between 1985 and 1999 where a supplemental data collection tool was used and focused on airway management, outcomes, and the role of the 1993 Difficult Airway Guidelines in litigation. Chi-square tests and multiple logistic regression analysis compared risk factors for death or brain damage (death/BD) from two time periods: 1985-1992 and 1993-1999. Results Difficult airway claims arose throughout the perioperative period: 67% upon induction, 15% during surgery, 12% at extubation, and 5% during recovery. Death/BD with induction of anesthesia decreased in 1993-1999 (35%) compared with 1985-1992 (62%; P &lt; 0.05; odds ratio, 0.26; 95% confidence interval, 0.11-0.63; P = 0.003). In contrast, death/BD associated with other phases of anesthesia did not significantly change over the time periods. The odds of death/BD were increased by the development of an airway emergency (odds ratio, 14.98; 95% confidence interval, 6.37-35.27; P &lt; 0.001). During airway emergencies, persistent intubation attempts were associated with death/BD (P &lt; 0.05). Since 1993, the Airway Guidelines were used to defend care (8%) and criticize care (3%). Conclusions Death/BD in claims from difficult airway management associated with induction of anesthesia but not other phases of anesthesia decreased in 1993-1999 compared with 1985-1992. Development of additional management strategies for difficult airways encountered during maintenance, emergence, or recovery from anesthesia may improve patient safety.

Malpractice in Cases of Pediatric Appendicitis

2016 ◽  
Vol 56 (3) ◽  
pp. 226-230 ◽  
Author(s):  
Veronica F. Sullins ◽  
Joshua D. Rouch ◽  
Steven L. Lee
Keyword(s):  
Patient Safety ◽  
Medical Malpractice ◽  
Pediatric Patients ◽  
Improve Patient Safety ◽  
Timely Diagnosis ◽  
Malpractice Claims ◽  
Common Causes ◽  
Medical Malpractice Claims ◽  
Improve Patient ◽  
Retrospective Database

Appendicitis is one of the most common diagnoses in children and is frequently the focus of alleged malpractice. Causes for medical malpractice claims and outcomes of disputes in pediatric patients with appendicitis are currently unknown. A retrospective database review of all medical malpractice claims concerning the diagnosis of appendicitis from 1984 to 2013 in pediatric patients was performed. Alleged claims, causes of malpractice, and outcomes were recorded and analyzed. Of the 203 included cases, failure or delays in diagnosing appendicitis are the most common causes of malpractice lawsuits and account for the majority of the largest payments to plaintiffs outcomes. Cases that ultimately went to trial resulted in defense verdicts in 67.5%. Mortality occurred in 19.9% of included cases. Timely diagnosis of appendicitis in children should be the focus of physicians across all specialties to improve patient safety and potentially reduce medicolegal liability.

scholarly journals Emergency Department and Urgent Care Medical Malpractice Claims 2001–15

2021 ◽  
Vol 22 (2) ◽  
Author(s):  
Kelly Wong ◽  
◽  
P. Divya Parikh ◽  
Kwon Miller ◽  
Mark Zonfrillo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Malpractice ◽  
Urgent Care ◽  
Malpractice Claims ◽  
Medical Malpractice Claims

scholarly journals Rates and Characteristics of Medical Malpractice Claims Against Hospitalists

2021 ◽  
Author(s):  
Adam C Schaffer ◽  
Chihwen Winnie Yu-Moe ◽  
Astrid Babayan ◽  
Robert M Wachter ◽  
Jonathan S Einbinder
Keyword(s):  
Internal Medicine ◽  
Clinical Judgment ◽  
Medical Malpractice ◽  
Odds Ratio ◽  
Injury Severity ◽  
High Stakes ◽  
General Internal ◽  
Malpractice Claims ◽  
Using Data ◽  
Medical Malpractice Claims

BACKGROUND: Hospitalists practice in high-stakes and litigious settings. However, little data exist about the malpractice claims risk faced by hospitalists. OBJECTIVE: To characterize the rates and characteristics of malpractice claims against hospitalists. DESIGN, SETTING, AND PARTICIPANTS: An analysis was performed of malpractice claims against hospitalists, as well as against select other specialties, using data from a malpractice claims database that includes approximately 31% of US malpractice claims. MAIN OUTCOMES AND MEASURES: For malpractice claims against hospitalists (n = 1,216) and comparator specialties (n = 18,644): claims rates (using a data subset), percentage of claims paid, median indemnity payment amounts, allegation types, and injury severity. RESULTS: Hospitalists had an annual malpractice claims rate of 1.95 claims per 100 physician-years, similar to that of nonhospitalist general internal medicine physicians (1.92 claims per 100 physician-years), and significantly greater than that of internal medicine subspecialists (1.30 claims per 100 physician-years) (P < .001). Claims rates for hospitalists nonsignificantly increased during the study period (2009-2018), whereas claims rates for four of the five other specialties examined significantly decreased over this period. The median indemnity payment for hospitalist claims was $231,454 (interquartile range, $100,000-$503,015), significantly higher than the amounts for all the other specialties except neurosurgery. The greatest predictor of a hospitalist case closing with payment (compared with no payment) was an error in clinical judgment as a contributing factor, with an adjusted odds ratio of 5.01 (95% CI, 3.37-7.45). CONCLUSION: During the study period, hospitalist claims rates did not drop, whereas they fell for other specialties. Hospitalists’ claims had relatively high injury severity and median indemnity payment amounts. The malpractice environment for hospitalists is becoming less favorable.

scholarly journals A Descriptive Study on the Civil Lawsuits of Medical Malpractice Occurred during Psychiatric Ward Treatment

2020 ◽  
Vol 17 (9) ◽  
pp. 865-870
Author(s):  
Song Ii Ahn ◽  
Won Lee ◽  
Dong Ho Song
Keyword(s):  
Improve Patient Safety ◽  
Psychiatric Inpatient ◽  
Facility Management ◽  
Psychiatric Ward ◽  
Malpractice Claims ◽  
Common Diagnosis ◽  
Civil Lawsuits ◽  
Actual Harm ◽  
Risk Patients ◽  
Improve Patient

Objective Medical accidents have resulted in actual harm for patients, been costly for health care system, and diminished trust for both patients and practitioners. The present study analyzed malpractice claims related to accidents in psychiatric inpatient units.Methods This study analyzed defendants, cases and plaintiffs or patients characteristics, degrees of injury, and types of accidents in 85 civil malpractice suits filed from 2005 to 2015 with a focus on the methods and locations of suicides.Results Most defendants were psychiatrists (n=43). Of the 85 cases, 56 (65.9%) were decided in favor of the plaintiff, most commonly on the grounds of negligence and violation of sound facility management principles. The most common diagnosis of patients was schizophrenia (n=31). The damages were deaths in 52 cases and injuries or other damages in the remaining 33 cases. The most common accident was suicide (n=28), followed by escape attempts (n=15). The most common suicide method was hanging (n=21), which was usually committed in the private room using objects like door handles.Conclusion To reduce medical accidents, medical staff should monitor high-risk patients closely and constantly. Sufficient numbers of well-trained personnel are required to meet this standard. Reducing environmental hazards such as removing anchor points and installing door locking systems will improve patient safety.

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