0 10 20 30
4%
of surgical claims
allege a failure in
clinical judgment
and/or communication.
Documentation of High-Risk Presentations:
ED-RELATED LIABILITY
CLAIMS AT A GLANCE
ED-RELATED LIABILITY CLAIMS AT A GLANCE
N = 2,521 risk management issues in closed claims between 2014 and 2018 with a surgical allegation.
1
Through the Lens of Liability Claims
General Surgery
Orthopedic Surgery
Neurosurgery
0 10 20 30
A DOSE OF INSIGHT
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.
0 20 40 60 80
Collaborative Agreements:
top conditions that trigger claims
0 10 20 30
3
Reduce Distractions. Improve Outcomes.
Recurrent themes in surgical risk.
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.
What you’ll learn from this report
Specific areas of greatest vulnerability during the surgical episode of care — preoperative, intraoperative, and postoperative — and how you can reduce risk at each stage.
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.
20%
Download white paper
GENERAL PRINCIPLES FOR
MANAGING RISK IN ED
Medication-related
Insurance products provided by Medical Professional Mutual Insurance Company and its subsidiaries.
Risk Management Recommendations:
Engineering Safe and Reliable Triage
Diagnosis-related
Download white paper
of claims from among more than
50 surgical categories involve
just three specialties.
800.225.6168 | coverys.com
78%
7%
4%
3%
3%
Emotional Only
Temporary Insignificant
Temporary Minor
Temporary Major
Permanent Minor
Permanent Significant
Permanent Major
Permanent Grave
Death
of the more than 10,000 claims analyzed by Coverys across a five-year period involved surgical allegations.
Which case scenarios, conditions, and patient populations dominate the claims data.
25%
800.225.6168 | coverys.com
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.
Credentialing:
26%
25%
17%
13%
8%
5%
4%
1%
TOP SURGICAL ALLEGATIONS
47%
Technical Skill
Clinical Judgment
Communication
Behavior-related
Documentation
Administrative
Clinical Systems
Education/Training:
Use an evidence-based triage classification tool. Ensure all triage nurses receive annual triage education in assessment and the use of the tool.
The complex nature of emergency medicine claims and issues unique to ED risk.
What you’ll
learn from
this report
MEDICAL LIABILTY INSURANCE • BUSINESS ANALYTICS • RISK MANAGEMENT • EDUCATION
What can be done to reduce risk during emergency department (ED) visits — including new processes, practices, attitudes, training, and improved communications.
COPYRIGHTED
ADDITIONAL TOPICS IN WHITE PAPER
0 10 20 30 40
2
Process Vulnerabilities During the Emergency Department Episode of Care
Cardiac/vascular
Infection
Neurologic
Medication-related
Fracture/dislocation
GI-related
Psychiatric/suicide
Compliance:
View the complete white paper including:
3
The complex nature of emergency medicine claims and issues unique to ED risk.
N = 1,362 closed claims between 2014 and 2018 with an ED location.
Download white paper
23%
18%
8%
7%
7%
6%
6%
Through the Lens of Malpractice Claims
Surgery-related liability claims at a glance
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
Reassess patients who are waiting and do so at intervals appropriate for their symptoms or conditions.
The complex nature of surgical claims and issues unique to caring for patients before, during, and after surgery.
56%
Download white paper
CASE
STUDY
Medical
treatment
JUNE 2019
COPYRIGHTED
Insurance products provided by Medical Professional Mutual Insurance Company and its subsidiaries.
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.
9%
General Principles for Managing Risk and Improving Patient Safety in the ED
27%
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.
THREE EXAMPLES
FROM THE WHITE PAPER
1
39%
17%
10%
9%
7%
6%
5%
2
N = 10,263 traditional MPL closed claims between 2014 and 2018.
Emergency Department
Risks
TOP SURGICAL SPECIALTIES THAT TRIGGER CLAIMS
22%
17%
8%
Reduce Distractions. Improve Outcomes.
N = 2,579 closed claims between 2014 and 2018 with a surgical allegation.
*Injury severity based on National Association of Insurance Commissioners (NAIC) codes.
Top Claims LocATIONS
0 10 20 30 40
N = 2,579 closed claims between 2014 and 2018 with a surgical allegation.
N = 1,362 closed claims between 2014 and 2018 with an ED location.
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.
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.
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
Surgery Risks
Specific areas of greatest vulnerability during the emergency department episode of care — when and where risk is the highest, why, and for whom.
A DOSE OF INSIGHT
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.
Surgery/procedure-related
Risk trends in the top surgical specialties to trigger claims.
CASE STUDY
The most common conditions identified on ED claims involve cardiac or vascular illnesses (23%), followed by infections (18%).
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.
1%
3%
17%
31%
19%
16%
3%
1%
9%
Top Risk management issues
MEDICAL LIABILTY INSURANCE • BUSINESS ANALYTICS • RISK MANAGEMENT • EDUCATION
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.
Performance
Retained Foreign Body
Unnecessary Procedure
Wrong Side/Site/Patient
Delay in Surgery
INJURY SEVERITY*
How common societal trends impact ED trends.
N = 1,881 closed claims between 2014 and 2018 with a surgical allegation and a named provider.
of surgery injuries are
permanent significant or
worse, with 9% resulting
in death.
Top ALLEGATIONS
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.
29%
Surgery
Physician office
Inpatient unit
Emergency dept.
Lab/testing
L&D/nursery
Other
Urgent Care
of surgical allegations involve practitioner performance during the procedure itself.
78%
CONTACT INFORMATION