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Analysis

How to Manage Malpractice Risk in Your Emergency Department

By Christopher Cheney  
   June 25, 2019

There are a several areas where hospitals can manage ED malpractice risk, including medical condition diagnosis and opioid prescribing.

There are dozens of actions that health systems and hospitals can take to manage malpractice risk in their emergency departments, a new report published today says.

Emergency departments (EDs) are a crucial frontline healthcare setting, with more than 138 million visits to emergency rooms annually. EDs are the fourth most common healthcare setting for malpractice claims, according to Coverys, a medical liability firm that insures 42,000 medical professionals and 800 healthcare organizations.

A Coverys report published today on malpractice claims in EDs is based on an analysis of more than 1,300 medical liability claims from 2014 to 2018. The report features several key data points:

  • EDs accounted for about 13% of all medical liability claims. Surgery was the top target for medical liability claims, accounting for about 26% of claims.
     
  • Failure or delay in making a diagnosis accounted for 56% of ED claims.
     
  • Cardiac and vascular illnesses were the most common conditions identified on ED claims, accounting for 23% of the total, followed by infections (18%) and neurological conditions (8%).
     
  • More than one-third of ED claims involved the death of a patient.
     
  • The top risk management issues in EDs were clinical judgment (44%), clinical systems (10%), and documentation including electronic health records (10%).

The Coverys report provides risk management recommendations for 11 areas of ED operations and concerns:

  • Transport and arrival
     
  • Crafting safe and reliable triage
     
  • Patient safety in waiting rooms
     
  • Improving diagnostic accuracy
     
  • Enhancing diagnostic and laboratory testing
     
  • Approaches to specialty consultations
     
  • Admission and transfer processes
     
  • Opioid prescribing
     
  • Diversity such as care of transgender patients
     
  • Treating repeat patients
     
  • Reducing and preventing the boarding of patients

Improving diagnostic accuracy
 

Given that most ED malpractice claims involved failure or delay in making diagnoses, Coverys' Top 5 risk management recommendations are designed to improve diagnostic accuracy, Ann Burke, RN, director of risk management at the Boston-based company, told HealthLeaders.

1. Care transitions: EDs should commit to enhancing communication handoffs at all transitions of care based on a policy and structure for communication of patient information. 

"Committing to improve communication is a first step to improving patient safety. Using standardized handoff processes to ensure crucial information is clearly communicated and transferred during care transitions is essential to safely moving the patient through the ED episode of care," Burke said.

2. Patient evaluation: EDs should ensure that patient evaluation occurs on an ongoing basis during the ED episode of care by requiring documentation of patient status at prescribed intervals, she said. "Concise and timely documentation cannot be understated as a critical communication component in patient safety."

3. Decision support: EDs should implement clinical decision support tools to assist clinicians in the diagnostic process, such as practice guidelines for high-risk presentation, clinical decision applications, and providing access to a dedicated radiologist and pharmacist to assist with diagnosis and treatment, Burke said.

"Because of the nature of the environment—fast paced, limited ability to elicit medical history, and high acuity—in which they work, ED providers should consider using additional resources that can help them arrive at an accurate and timely diagnosis."

4. Team effort: ED clinicians should communicate clearly and efficiently with laboratory and radiology professionals, as well as other relevant healthcare providers, she said. "Communication between diagnostic departments, other providers, and ED providers is an area where patient safety can be improved with the implementation and standardization of communication protocols."

5. Test results: EDs should develop a protocol to manage communication of outstanding test results for the patient, primary care provider, and consultants. The protocol should be hardwired into everyday routines such as customizing an electronic system that supports the protocol and its objectives, Burke said.

"Without a strong system in place, test results that are outstanding when a patient is discharged or transferred from the ED may place the patient at risk. It is important that a follow-up system is in place to ensure patients and providers receive timely notification."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Emergency departments are the fourth most common healthcare setting for malpractice claims.

In a recent analysis of more than 1,300 ED medical liability claims, failure or delay in making a diagnosis accounted for 56% of claims.

More than one-third of ED claims involved the death of a patient.


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