A Review of Medical Malpractice Claims from the CRICO Comparative Benchmarking System

Transcription

1 A Review of Medical Malpractice Claims from the CRICO Comparative Benchmarking System (CBS: a national database of medical malpractice claims from captive & commercial insurers across the US ) Note: I have nothing to disclose. Dana Siegal, Director of Patient Safety and (interim) AVP; CRICO of the Harvard Medical Institutions

2 Data Source: CRICO Comparative Benchmark System Participating organizations from across the US submit their medical malpractice cases for coding & analysis of Claims Files Medical Records Source Data Medical malpractice claims and suites > 500,000 Captive and Commercial Insurers 25 US Entities Hospitals / Healthcare entities: AMCs / Teaching / Community Settings ~ 400 Physician (and APC) Providers ~180,000 % of in the US Malpractice Claims ~ 30%

3 Surgical Tx Medical Tx Diagnosis- Related Medication- Related Safety & Security Anesthesia- Related Tx OB-Related Tx Pt Monitoring Other NUMBER OF CASES TOTAL INCURRED Diagnostic-related claims are third largest in volume and highest in lost dollars (indemnity and expenses) Top Major Allegations in CBS Cases 25,789 cases $4.5B total incurred number of cases total incurred 8,000 $1,400,000,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 5,233 cases / $1.3B (I/E) $1,200,000,000 $1,000,000,000 $800,000,000 $600,000,000 $400,000,000 $200,000,000 0 $0 CBS includes all med mal claims from > 500 healthcare / hospital entities and 180,000 physician represents ~30% of US claims 3 N for this study =25,789 PL cases asserted 1/1/10 12/31/14 and fully coded with all clinical and legal attributes for comparative analysis.

4 5,233 cases $1.3B total incurred Failure / delay in diagnosing cancer represents nearly 1/3 of all diagnosis-related malpractice cases Cancer-related Cardiac diseases 31% 29% Injury (Ortho) Digestive / GI system 4% 6% 7% 10% 12% Nervous system and sense organs Cerebrovascular Other CBS N=5,233 PL cases asserted 1/1/10 12/31/14 with a diagnosis-related major allegation. 4

5 Distribution of diagnosis-related cases where cancer was the missed / delayed diagnosis 5,233 cases $1.3B total incurred 29% All other final diagnoses CBS N=5,233 PL cases asserted 1/1/10 12/31/14 with a diagnosis-related major allegation. 5

6 5,233 cases $1.3B total incurred Top 5 Primary Responsible Services in diagnosisrelated malpractice cases with cancer as a final Dx 31% 29% Primary Responsible Services in Cancer related claims 4% 6% 7% 10% 12% - General Medicine (IM/FM) 26% - Radiology 18% - GYN 9% - Dermatology 6% - Pathology 6% All other final diagnoses CBS N=5,233 PL cases asserted 1/1/10 12/31/14 with a diagnosis-related major allegation. 6

7 Clinical Judgement was the root cause in 72% of the Cancer related cases - the top issues identified include o Failure to order diagnostic test o Misinterpretation of diagnostic study o Failure to obtain a consult o Failure to reconcile an abnormal finding o Misinterpretation of diagnostic study RADIOLOGY 18% Most Common Missed Cancers Breast Lung GI Urinary PATHOLOGY 6% Most Common Missed Cancers GYN Skin Breast Head and Neck

8 Additional causation factors include: Communication to Provider Incidental Findings Poor Technique Communication to Provider RADIOLOGY 18% PATHOLOGY 6% Most Common Missed Cancers Most Common Missed Cancers Breast GYN Lung Skin GI Breast Urinary Head & Neck

9 Medicine Radiology Surgery Pathology OB/Gyn PERCENT OF CASES Comparing Responsible Service for cancer related diagnostic cases: Academic vs. Community (2012) Top Responsible Services in Cancer Diagnosis Cases 45% Academic Medical Centers Community Hospitals 40% 35% 41% 40% 30% 25% 31% 20% 15% 10% 5% 19% 16% 8% 12% 10% 7% 6% 0% 9

10 Comparative view; cancer cases types, Academic vs. Community setting (2012 study) Top Cancers by Clinical Environment: Benign neoplasms Breast Bronchus, lung Colorectal Lymphatic and hematopoietic tissue Male genital organs Neoplasms of unspecified nature or uncertain behavior Other gastrointestinal cancer Other primary Ovary and other female genital organs Secondary malignancies Skin Urinary organs Uterus and cervix Academic Medical Center Community Hospital 0% 5% 10% 15% 20% 25% 30% PERCENT OF DX CASES PER ENVIRONMENT AMC N=222 PL cases closed 1/1/08 12/31/12 with a diagnosis-related major allegation and a final diagnosis of cancer. Community N=125 PL cases closed 1/1/08 12/31/12 with a diagnosis-related major allegation and a final diagnosis of cancer. 10

11 Solutions that address primary contributors focus on: o Technical Skills (teaching, training, supervision) o Communication (between providers and w/ patient ) o Guidelines (test ordering & process)

12 First published in 1996 Last reviewed in 2014 First published in 2004 Last reviewed in 2014

13 For copies of this (or other Annual Benchmark Reports) please visit: Or contact Dana dsiegal@rmf.harvard.edu 13