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Malpractice Data Analysis Offers Window into Surgical Error

Heather Comak, for HealthLeaders Media, July 13, 2010

The term "malpractice" often invokes images of courtrooms and spiraling insurance rates, but malpractice data can often be used for the purpose of fostering patient safety. In the surgical world, that information is increasingly more important as the amount and types of surgeries performed climb each year.

In its 2009 annual benchmarking report, CRICO/RMF (originally two companies, Controlled Risk Insurance Company and the Risk Management Foundation), the patient safety and medical malpractice company owned by and serving the Harvard medical community among others, analyzed malpractice claims and provided that information to its members as well as the public.

Not surprisingly, communication, disclosure, diagnosis, and technical performance were common reasons for claims. The report's authors hope the data analysis and benchmarking capabilities included in the report will influence patient safety initiatives at hospitals in the near future.

"We feel that malpractice activity is what I would term 'the tip of the iceberg,' " says Bob Hanscom, JD, vice president of loss prevention and patient safety for the Risk Management Foundation and RMF Strategies, a division of CRICO/RMF. "Malpractice activity is always above the surface of the water; it has the potential to be known to the public, it's always where something has really gone wrong. Our theory has always been if you analyze those malpractice cases as deeply as possible, they become a very rich, almost divining rod as far as where those vulnerabilities are in the real-time environment."

The report is based on data from 3,300 surgical malpractice cases that took place between 2003 and 2008. The data, collected through RMF Strategies' Comparative Benchmarking System, show that surgical errors occur during all three stages of surgery—pre, intra, and post—and that open communication is one of the main ways of preventing errors from occurring, in addition to clinicians possessing the cognitive and technical skills required for complicated procedures.

The malpractice data analysis included in the report has already helped some member hospitals examine how to change existing processes to improve patient safety.

"We have been able to use the report to more effectively engage our physicians in process improvement," says Pat Sullivan, PhD, vice president of quality and patient safety at the University of Pennsylvania Health System (UPHS). "I'm a big believer in peer processes, and some of our most successful initiatives are those that come from within and are not necessarily top-down."

Sullivan says that clinicians at her facility were interested to see how they compared with similar types of institutions in the areas of malpractice risk and patient safety, and doing so has motivated them to become involved.

It's also likely that the surgeons at UPHS and other hospitals are more apt to recognize the need to improve and get on board with any new initiatives because the data are evidence-based, says Hanscom.

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