Coverys: New Research Analyzes Diagnostic-Related Medical Malpractice Claims

Diagnosis-related events are the single largest root cause of medical professional liability claims, accounting for 33 percent of all claims and 47 percent of indemnity payments, according to Boston-based medical professional liability insurance provider Coverys.

The insurer’s latest “Dose of Insight” report, provides a data-driven look at the state of diagnostic inaccuracy in the United States. The report analyzes more than 10,000 closed medical professional liability claims at Coverys across a five-year period (2013-2017) to identify the root causes of diagnostic error and, subsequently, how to prevent errors in the future. The report follows closely on the heels of Coverys’ inaugural Dose of Insight report focused on medication-related errors which was released in October.

“Diagnostic accuracy is far from simple, and diagnosis-related events have come to represent the single largest root cause of medical professional liability claims, leading to serious and sometimes deadly results,” said Robert Hanscom, vice president, Business Analytics for Coverys and co-author of the report. “To help improve diagnostic accuracy, improve patient safety, and reduce claim frequency, physicians and healthcare providers need data-driven insights, fresh perspectives, and new ways of thinking about the everyday activities that contribute to making a patient diagnosis.”

The report found that there are risks in each of the four key steps in the diagnosis process.

Key findings from the report include:

• 53 percent of diagnosis-related claims include risk management issues involving poor clinical decision-making.
• 54 percent of diagnosis-related claims are high severity cases, and 36 percent result in death.
• 36 percent of diagnosis-related claims stem from outpatient (office setting) locations.
• 35 percent of diagnostic errors occur in non-emergency department outpatient settings, such as physicians’ offices or clinics.
• The leading condition involved in diagnosis-related claims is cancer (27 percent), followed by infection (13 percent), cardiac/vascular conditions (8 percent), fracture/dislocation (5 percent), and myocardial infarction (4 percent).
• 24 percent of diagnosis-related claims take place in the emergency department and urgent care facilities.
• 33 percent of diagnosis-related claims allege the decision-making breakdown happened as a result of a failure during the evaluation of a patient.
• Testing is involved in more than half of all diagnosis-related medical professional liability claims, with failures in ordering, performing, receiving/transmitting, and interpreting test results accounting for more than 50 percent of diagnosis-related claims.

“Every year in the United States, nearly 84 percent of all adults and 93 percent of all children make a total of 125.7 million hospital outpatient visits and 884.7 million physician office visits – but on a national scale, it has been estimated that 10-20 percent of all diagnoses for these patients are inaccurate,” said Hanscom. “This issue is no small matter, but there is much that can be done by providers and healthcare organizations to reduce the frequency and severity of such errors. It is our hope that the stories in our claims data provide not just a dose of reality, but also encourage medical professionals to implement changes that ultimately make patients and practices safer.”

The report authors provide a number of ways the process can be improved to reduce diagnostic inaccuracy. One way is by developing checklists to use in the physician/patient conversation during the initial history and physical.

According to the report, “four discrete phases of testing (ordering, performance, receipt/transmittal, and interpretation) trigger a disturbing 52 percent of diagnosis-related claims and 55 percent of indemnity payments.” The authors recommend a better system to track patient specimens and a process to allow patients to obtain and understand results.

The authors also recommend developing a consultation protocol when referrals may be necessary.

The report, co-authored by Hanscom, Maryann Small, director of Data Governance & Business Analytics for Coverys, and Ann Lambrecht, senior risk specialist for Coverys, is available for download on the Coverys website.

Source: Coverys