Surgery-related liability claims at a glance
Through the Lens of Malpractice Claims
Surgery Risks
A DOSE OF INSIGHT
Coverys is a leading provider of medical professional liability insurance to help protect healthcare professionals. We are committed to providing data-driven insights to reduce claims and proactive risk management and education services to increase quality patient outcomes. Our services are designed to help clients reduce distractions to improve clinical, operational, and financial outcomes.
Insurance products provided by Medical Professional Mutual Insurance Company and its subsidiaries.
800.225.6168 | coverys.com
COPYRIGHTED
MEDICAL LIABILTY INSURANCE • BUSINESS ANALYTICS • RISK MANAGEMENT • EDUCATION
Reduce Distractions. Improve Outcomes.
Recurrent themes in surgical risk.
What you’ll
learn from
this report
A Fresh Approach to Claims Data
Recurrent Themes in Surgical Risk
Process Vulnerabilities During the Surgical Episode of Care including case studies
Top Surgical Specialties to Trigger Claims: General Surgery, Orthopedic Surgery, Neurosurgery General Principles for Managing Risk and Improving Safety
The Coverys Value-Based Model to Improve Outcomes
View the complete white paper including:
Risk trends in the top surgical specialties to trigger claims.
Specific areas of greatest vulnerability during the surgical episode of care — preoperative, intraoperative, and postoperative — and how you can reduce risk at each stage.
The complex nature of surgical claims and issues unique to caring for patients before, during, and after surgery.
The complex nature of emergency medicine claims and issues unique to ED risk.
of surgical claims
allege a failure in
clinical judgment
and/or communication.
27%
COPYRIGHTED
Coverys is a leading provider of medical professional liability insurance to help protect healthcare professionals. We are committed to providing data-driven insights to reduce claims and proactive risk management and education services to increase quality patient outcomes. Our services are designed to help clients reduce distractions to improve clinical, operational, and financial outcomes.
Insurance products provided by Medical Professional Mutual Insurance Company and its subsidiaries.
800.225.6168 | coverys.com
MEDICAL LIABILTY INSURANCE • BUSINESS ANALYTICS • RISK MANAGEMENT • EDUCATION
Download white paper
To view the complete white paper including where claim vulnerabilities lie in the ED process and risk recommendations to improve healthcare outcomes, please download below.
A Fresh Approach to Claims Data
Emergency Departments: The First Stop in the Medical Journey
Issues Unique to Emergency Departments
Diagnosis, Medical Treatment, and Medication-Related Issues
Communication Issues
Trends That Impact Safety
ADDITIONAL TOPICS IN WHITE PAPER
It’s imperative that medical record documentation of high-risk presentations is clinically pertinent and includes a triage assessment, a pertinent medical history, a history and physical, the medical care provided, and a disposition appropriate for the patient’s condition. High-risk presentations include: chest pain/MI, headache/stroke, abdominal/pelvic pain, infection/sepsis, pregnancy/labor, and psychiatric emergencies. These common complaints warrant close attention as 30% of ED claims involved cases that were cardiac-related or GI-related, two of the most common complaint types nationally.
Documentation of High-Risk Presentations:
EDs should review their practices as they relate to the Emergency Medical Treatment and Labor Act (EMTALA) to ensure that all patients, regardless of their ability to pay, receive a medical screening and appropriate stabilization prior to transfer or discharge.
Compliance:
Ensure that clear supervisory and/or collaborative practice protocols are in place for ED advanced practice providers that specify situations when consultation with or evaluation by the ED physician must occur.
Collaborative Agreements:
Implement policies and procedures to ensure a thorough, objective, evidence-based credentialing process and documentation for recently appointed and reappointed physicians, advanced practice providers, and locum tenens providers (as applicable). The process should include consideration of peer review, quality, and outcomes data.
Credentialing:
Ensure ED staff complete competency-based orientation and ongoing education, including with respect to high-risk clinical presentations. Document education and training in their employee files.
Education/Training:
General Principles for Managing Risk and Improving Patient Safety in the ED
3
Reassess patients who are waiting and do so at intervals appropriate for their symptoms or conditions.
Use an evidence-based triage classification tool. Ensure all triage nurses receive annual triage education in assessment and the use of the tool.
Have one or more RNs designated as triage nurses. This is a professional responsibility and must not be delegated to anyone who has not completed the required training and competency evaluation from nursing leadership to function in this role.
Risk Management Recommendations:
Engineering Safe and Reliable Triage
A man in his late 50s arrived at the ED via EMS, complaining of shortness of breath and reporting that his primary care provider had diagnosed him with pneumonia earlier that day.
The patient had poorly controlled diabetes, and an EKG performed during transport indicated a right bundle branch block and sinus tachycardia. The nurse who performed the patient’s triage when he arrived deemed him “non-urgent.”
Nearly an hour and a half later, the patient had not been evaluated by a physician, and his condition was deteriorating. An emergency physician just coming on duty was asked to evaluate the patient, and a code was called.
After intubation, the patient went into cardiac arrest, resuscitation efforts were unsuccessful, and the patient was pronounced dead. Cause of death was recorded as cardiac arrest and sepsis, and the resulting claim alleged negligent ED triage of the patient.
Process Vulnerabilities During the Emergency Department Episode of Care
CASE STUDY
2
Surgery/procedure-related
Medication-related
Medical
treatment
Diagnosis-related
N = 1,362 closed claims between 2014 and 2018 with an ED location.
4%
9%
20%
56%
The majority of allegations for ED claims involved a failure or delay in making a diagnosis including the lack of an appropriate patient/family history and physical as well as inappropriate ordering of diagnostic tests.
Top ALLEGATIONS
N = 1,362 closed claims between 2014 and 2018 with an ED location.
0 10 20 30
23%
18%
8%
7%
7%
6%
6%
Cardiac/vascular
Infection
Neurologic
Medication-related
Fracture/dislocation
GI-related
Psychiatric/suicide
The most common conditions identified on ED claims involve cardiac or vascular illnesses (23%), followed by infections (18%).
top conditions that trigger claims
0 10 20 30
N = 10,263 traditional MPL closed claims between 2014 and 2018.
26%
25%
17%
13%
8%
5%
4%
1%
Surgery
Physician office
Inpatient unit
Emergency dept.
Lab/testing
L&D/nursery
Other
Urgent Care
The ED is the fourth highest location to trigger claims. 13% of all medical professional liability (MPL) claims involve care that occurred in the ED.
Top Claims LocATIONS
ED-RELATED LIABILITY CLAIMS AT A GLANCE
1
GENERAL PRINCIPLES FOR
MANAGING RISK IN ED
CASE
STUDY
ED-RELATED LIABILITY
CLAIMS AT A GLANCE
THREE EXAMPLES
FROM THE WHITE PAPER
1
2
3
The complex nature of emergency medicine claims and issues unique to ED risk.
Which case scenarios, conditions, and patient populations dominate the claims data.
How common societal trends impact ED trends.
What can be done to reduce risk during emergency department (ED) visits — including new processes, practices, attitudes, training, and improved communications.
Specific areas of greatest vulnerability during the emergency department episode of care — when and where risk is the highest, why, and for whom.
What you’ll learn from this report
Through the Lens of Liability Claims
Emergency Department
Risks
A DOSE OF INSIGHT
Reduce Distractions. Improve Outcomes.
JUNE 2019
Download white paper
Download white paper
Download white paper
0 10 20 30 40
N = 2,521 risk management issues in closed claims between 2014 and 2018 with a surgical allegation.
39%
17%
10%
9%
7%
6%
5%
Technical Skill
Clinical Judgment
Communication
Behavior-related
Documentation
Administrative
Clinical Systems
Top Risk management issues
N = 1,881 closed claims between 2014 and 2018 with a surgical allegation and a named provider.
0 10 20 30
22%
17%
8%
General Surgery
Orthopedic Surgery
Neurosurgery
TOP SURGICAL SPECIALTIES THAT TRIGGER CLAIMS
of claims from among more than
50 surgical categories involve
just three specialties.
47%
0 20 40 60 80
N = 2,579 closed claims between 2014 and 2018 with a surgical allegation.
78%
7%
4%
3%
3%
Performance
Retained Foreign Body
Unnecessary Procedure
Wrong Side/Site/Patient
Delay in Surgery
TOP SURGICAL ALLEGATIONS
of surgical allegations involve practitioner performance during the procedure itself.
78%
N = 2,579 closed claims between 2014 and 2018 with a surgical allegation.
*Injury severity based on National Association of Insurance Commissioners (NAIC) codes.
0 10 20 30 40
1%
3%
17%
31%
19%
16%
3%
1%
9%
Emotional Only
Temporary Insignificant
Temporary Minor
Temporary Major
Permanent Minor
Permanent Significant
Permanent Major
Permanent Grave
Death
INJURY SEVERITY*
of the more than 10,000 claims analyzed by Coverys across a five-year period involved surgical allegations.
25%
of surgery injuries are
permanent significant or
worse, with 9% resulting
in death.
29%
CONTACT INFORMATION