A new study shines light on medical errors and malpractice cases in pediatric care.
The types of malpractice claims involving children change over time, with infants under age 1 experiencing the highest severity injuries, a recent study found.
Earlier research found medical errors involving hospitalized children ranged from 1.81 to 2.96 per 100 discharges, and children at highest risk included those with special medical needs or dependence on a medical technology.
In a study published last month, The Doctors Company examined more than 1,200 claims filed on behalf of children. The data was segmented into four age categories: neonates, first month; first year, 1 to 11 months; child, 1 to 9 years; and teenager, 10 to 17 years.
"Diagnosis-related allegations were the most common allegation in all but the neonate age group. Age groups older than neonates experienced diagnosis-related claims in 34% to 44% of all claims and lawsuits in their age group," the study says.
The research includes several other key data points:
- Obstetricians were named in the highest percentage of cases at 24%
- 37% of the cases resulted in a payment to the claimant
- The median indemnity payment was $250,000, and the median expense to defend those claims was nearly $100,000
- Brain injuries accounted for the highest percentage of claims for all age groups: neonates, 48%; first year, 36%; child, 15%; and teenager, 11%
- Children in the first-year category of the claims experienced the highest death rate at 30%
Neonates were a high-risk category in the malpractice cases for several reasons, the lead author of the study told HealthLeaders.
"Care for neonates is problematic because babies in their first month of life are very vulnerable to harm. The birth process can be traumatic. Injuries suffered during childbirth include brain damage, brachial plexus injuries, lacerations from forceps, injuries to the scalp from vacuum-assisted deliveries, and infections," said Darrell Ranum, JD, vice president of patient safety and risk management at The Doctors Company.
Making accurate diagnoses in pediatric care can be daunting, Ranum said.
"Diagnosing patients is challenging because symptoms may not be specific to one or two conditions. Physicians must factor numerous pieces of information into their differential diagnosis. Diagnosing children can be more challenging than diagnosing adults. Younger children may not be able to articulate what they are feeling. Parents often contribute useful information; but in some situations, language barriers make this interaction more difficult."
Parents may fail to share crucial care clues, he said. "In some cases, parents may not talk about information because they don't remember to tell their physician, or they don't understand the clinical significance of the information. Family history that includes inherited conditions is one example of information that may be overlooked."
There are several approaches to avoid medical errors and malpractice claims involving children, Ranum said.
"Develop systems that support physicians and other healthcare providers. Clinicians should not depend on memory to make clinical decisions. Like everyone else, clinicians can be distracted, overloaded with information from multiple sources, and impacted by their feelings following unpleasant interactions."
Examples of support systems include good documentation and structured reminders, he said.
"Tracking systems for vaccinations, lab tests, radiographic studies, and medication orders that require monitoring all help clinicians to provide the right care at the right time. Many claims in primary care are related to lost test results or X-ray findings that would have prompted a clinical response. With no tracking system, physicians are often unaware of what they don't know."
Training can be pivotal in high-risk situations, Ranum said.
"Many of the conditions that result in patient harm occur infrequently. Rare critical situations resulting in high-severity injuries should prompt simulation training. This prepares clinicians to respond with a prompt and skilled response. Good examples in obstetrics for simulation training include conditions that could result in oxygen deprivation to a fetus before birth and shoulder dystocia during the birth process."
Communication is also crucial, he said. "An essential strategy is being prepared for questions or concerns raised by parents and other caregivers. Office staff should know what concerns should prompt a physician's review or immediate care. These calls are often the first opportunity to address life-threatening conditions."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Diagnosis in pediatric-care cases can be daunting, especially when treating infants and other children who are incapable of cooperating with clinicians.
In a recent study, brain injuries accounted for the highest percentage of malpractices claims for all age groups of children.
There are several approaches to avoid medical errors and malpractice claims involving children such as simulation training for high-risk care situations.