Search results for "Hospitals"

This piece explores the risk of recurring medicolegal events among providers who have received unsolicited patient complaints, faced disciplinary actions by medical boards, or accumulated malpractice claims.

This retrospective study of a claims database found that medical malpractice claims declined significantly between 1992 and 2014, but mean payment amounts increased at the same time. Diagnostic error was the overall most common reason for a claim, affirming the importance of improving diagnosis.

Medical malpractice law is intended to foster high quality care and discourage negligence among health care providers. This observational study took advantage of differing malpractice laws by state and examined the extent to which the malpractice environment is associated with hospital quality. Investigators assessed quality using several measures: validated processes-of-care measures, such as whether evidence-based actions were appropriately taken for common conditions like myocardial infarction, pneumonia, heart failure, and surgical care; patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems; imaging efficiency as reported by Medicare's Hospital Compare website; AHRQ Patient Safety Indicators; and 30-day readmission and hospital mortality rates. There were no associations between any of these quality outcomes and the rate of paid claims per 100 physicians. Areas with a higher malpractice geographic cost index had lower 30-day mortality but higher readmission rates, and higher malpractice costs were correlated with more inefficiency in some types of imaging. The authors conclude that malpractice environment does not appear to be associated with quality, but higher malpractice costs may lead to overtreatment.

This retrospective observational study determined that state malpractice climate was not associated with postoperative outcomes. These data are consistent with previous studies suggesting that more stringent malpractice law does not prevent adverse events.

Risk management can contribute to proactive process improvement. This commentary describes the development and evaluation results of a long-term collaborative program to change risk management practice and reduce medical malpractice claims. Strategies utilized in the program included RiskRounds and web-based modules.

This book provides information on various patient safety topics and highlights the importance of detecting errors. Chapters will include discussions about second victims, improvements in medication safety, and the economic impact of unsafe care.

Prior research demonstrates that a small percentage of physicians are responsible for a significant proportion of paid malpractice claims. This study found that 1.8% of physicians accounted for 50% of paid claims reported to the National Practitioner Data Bank over 25 years. The authors suggest that the adverse impact of such outlier physicians needs to be addressed in order to ensure patient safety.

Medical liability reform has been a subject of considerable debate. This special issue includes numerous articles exploring topics related to medical liability and patient safety. One study examined whether health care organizations and malpractice insurers could collaborate to implement a communication and resolution program to improve health care quality. Another article described how efforts to reduce perinatal harm, largely through standardization of best practices and implementation of team training, led to a reduction in malpractice claims. An observational study showcased how implementation of AHRQ's Communication and Optimal Resolution toolkit (CANDOR) at a single health system was associated with improved identification of safety issues and a decline in malpractice claims. Concluding editorials highlight lessons learned from an AHRQ-funded multifaceted intervention to mitigate risk in ambulatory care and make the case for creating a national surveillance system for malpractice claims.

Medical malpractice claims represent a mechanism to address medical errors. This pre–post study found that malpractice claims for a large university health system declined substantially after a state law was enacted that reduced patients' ability to sue and collect damages following medical errors. Data demonstrated that the university worked to provide compensation to some patients involved in cases that were not viable for litigation. The authors call for limiting nondisclosure agreements following claim settlement in order to enhance transparency.

Communication and resolution programs emphasize transparency through early disclosure of adverse events and expedite attempts to resolve incidents. This study examined whether collaboration of health care organizations and malpractice insurers with state regulators through the development of a communication and resolution program certification pilot would enhance health care quality. The authors concluded that the development of such a program can lead to improved patient-centered accountability following an adverse event. They suggest that when designing such a process, care must be given to ensure that regulators' responsibility to act in the public's best interest is not compromised.

Assuming its dosing was similar to morphine, a physician ordered 4 mg of IV hydromorphone for a hospitalized woman with pain from acute pancreatitis. As 1 mg of IV hydromorphone is equivalent to 4 mg of morphine, this represented a large overdose. The patient was soon found unresponsive and apneic—requiring ICU admission, a naloxone infusion overnight, and intubation. While investigating the error, the hospital found other complaints against that particular physician.

Improving patient safety provides an opportunity to reduce malpractice claims and associated costs, particularly in higher risk clinical areas such as obstetrics. This study examined medical malpractice claims and cost data in the perinatal units of hospitals before and after implementation of safety interventions focused on decreasing perinatal harm. Interventions consisted largely of standardizing best practices and implementing team training. Investigators found that improving perinatal safety led to substantial reductions in both the frequency and total cost of malpractice claims. The role that the medical liability system plays in driving up health care costs and in promoting the practice of defensive medicine—which can lead to adverse events through unnecessary tests and procedures—was highlighted in a past WebM&M commentary.

Patients are at risk for adverse events after they transition from hospital to home. This study used review of malpractice claims and stakeholder focus groups to inform planning tools for postdischarge care transitions. Pilot testing of the tools demonstrated acceptability and feasibility for patients and providers. These results suggest that malpractice data can inform safety improvement approaches.

Closed claims have been considered a source for adverse event data for years, and recently such data has been utilized to inform safety improvement work. This newspaper article reviews several organizational efforts that use claims data to determine factors that contribute to failure and strategies to address them, including process redesign and enhanced patient education.

Communication failures are known to contribute to medical errors. Analyzing more than 7000 cases in which communication breakdowns led to patient harm, this report explores selected specialties where such failures occur and discusses opportunities to improve information sharing among health care providers.

Although heath information technology (IT) has improved patient safety, studies have shown that implementing electronic health records can introduce new errors. This study examined closed malpractice claims related to health IT. Most cases occurred in ambulatory care settings, suggesting that current health IT may not be optimally designed to support safety in those settings. Cases involving medication errors, diagnostic errors, or treatment complications were almost equally prevalent, indicating that health IT vulnerabilities span multiple tasks and functions. Software design issues and implementation problems also played a role in these incidents. These findings emphasize the need to reexamine health information technologies and how they are implemented in health care systems to enhance safety. A recent PSNet perspective examined challenges in health IT implementation, and another perspective discussed the need for innovations in health IT usability.

Defensive medicine—the practice of performing potentially unnecessary procedures or diagnostic tests to avoid the threat of malpractice liability—is thought to contribute to high health care costs in the United States. Because procedures and tests carry risks of complications, defensive medicine also may lead to adverse events. This secondary data analysis examined prospectively whether physicians who performed more cesarean deliveries (considered to be defensively motivated) were more or less likely to be subject to malpractice claims compared with those performing fewer cesarean deliveries. Researchers adjusted for available clinical characteristics and still found that obstetricians who performed more cesarean deliveries were less likely to have subsequent alleged malpractice incidents. This finding suggests that defensive medicine may be a rational physician response to the current malpractice environment, and underscores the patient safety rationale for malpractice reform. A previous WebM&M commentary discusses the causes and consequences of defensive medicine.

Reporting on trends associated with medical malpractice, how the same physicians tend to get sued, and reasons patients file claims, this newspaper article discusses better communication and physician behavior change as ways to reduce malpractice risk. The early resolution program at University of Michigan is highlighted as an effective model for improvement.

Efforts to increase incident reporting may lead to reporting of events that do not have risk for subsequent litigation. This study demonstrated that modeling based on automated data mining of event reports could identify reports that were most likely to be associated with subsequent malpractice claims. This suggests that actions to address adverse events, such as disclosure programs, could be deployed more efficiently using an automated algorithm to detect high-risk event reports in real time.

Analysis of malpractice claims can identify trends and determine opportunities for improvement. This commentary discusses an incident involving delayed diagnosis of Ebola in the United States and other diagnostic failures to illustrate how local and comparative data can be utilized to inform the design of risk reduction strategies.