Medical Malpractice in the Emergency Department

It’s no secret that medical malpractice costs the healthcare system billions of dollars every year-from insurance costs to paid claims to legal fees-not to mention the toll it takes on physicians and patients. Part of stopping malpractice is identifying why it happens and where it happens most often. A new study from medical liability insurer Coverys is hoping to do just that for emergency department claims.

The report, “A Dose of Insight - Emergency Department Risks: Through the Lens of Liability Claims” is based on an analysis of ED-related closed medical professional liability claims at Coverys across a five-year period from 2014 to 2018.

Overall, the report shows that EDs are the fourth-most common to trigger a malpractice claim in healthcare settings-potentially making this a huge area of concern. The report also finds that:

• 56% of claims involved a failure or delay in making a diagnosis

• The most common conditions cited in allegations are cardiac or vascular illnesses (23%) and infections (18%)

• 32% of the ED allegations involve permanent injuries and 38% involve grave injury or death

• 49% of all medication-related allegations involve three types of medications: antibiotics, opioids, and anticoagulants.

Related: Patient Control Over Health Data: Experts React

With these facts, says Ann Burke, director of Risk Management, Coverys, it is hoped that potential future malpractice claims can be avoided.

“It is our hope that healthcare executives,” Burke says, “together with their healthcare providers and risk, quality, and patient safety leaders, look at the information in the report armed with their current knowledge of patient safety issues in each phase of the ED episode of care and use that information to guide them on the areas where change is most needed.”

Burke adds that data like this can help to first identify and then mitigate risk-before any patients are harmed. “In order to make meaningful change,” Burke says, “healthcare executives must not only be aware of patient safety issues, but should also be the drivers of, and provide support for, ongoing patient safety strategies.

“EDs present a unique risk to providers in that they are essentially providing care to a stranger. The goal in sharing this information is to provide healthcare providers and organizations with insight into where the greatest exposures may exist in the ED episode of care and guide them in their patient safety strategies.” 

Another finding that Burke finds interesting lies in diagnosis-related claims (56% of claims), where 44% were found to have the diagnostic process break down during the initial history and physical examination.

“This is a significant finding,” Burke says. “Organizations should ensure that patient evaluation occurs on an ongoing basis by requiring documentation of patient status at prescribed intervals. Clinical decision support tools, such as practice guidelines for high-risk presentations, can be implemented to assist providers in the diagnostic process.

“Practitioners and staff should also work to enhance communication handoffs at all transitions of care based on policy. It is important to structure communication for patient information to avoid miscommunication errors and improve patient outcomes. A protocol should also be in place to manage communication of outstanding test results to the patient and primary care providers.”