Systems Issues Contribute to Malpractice Claims, Risk Management Executive Says


Examples of best practices from the system are available online in the “office practices” portion of the Risk Management Foundation's Web site:

PHILADELPHIA — There are just as many systems failures at the root of malpractice cases as individual errors or negligence, Dr. Luke Sato said at the annual meeting of the American College of Physicians.

For example, the Risk Management Foundation of the Harvard Medical Institutes Inc., the insurance carrier for 18 hospitals and about 10,000 physicians in the Massachusetts area, has spent nearly the same amount of money over the years on malpractice cases involving clinical support processes as on cases resulting from a problem with the patient-clinician interaction.

“What we see is that this is a process reengineering problem,” said Dr. Sato, assistant professor of medicine at Harvard University and chief medical officer and vice president of the Risk Management Foundation.

An analysis of 2,270 malpractice cases within the insurance carrier from September 1995 to August 2005 shows that there are four high-risk categories in their system—obstetrics, surgery, medication-related problems, and diagnosis-related problems.

The diagnosis-related cases are the most prevalent and the most expensive, Dr. Sato said. Those claims usually involve some type of delayed diagnosis, failure in diagnosis, or missed diagnosis, he said.

Dr. Sato advised physicians to take a look at their office processes and set up ways within the practice to gather and document information that is critical to both the continuity of care and to avoiding malpractice claims. For example, a large portion of diagnosis-related claims in the Harvard system were traced to inadequate documentation of areas such as family history, allergy status, and medication lists.

Physicians are also leaving themselves open to malpractice claims if they don't have proper systems for follow-up of abnormal test and lab results and other issues. Referral management is another key area to focus on, Dr. Sato said.

Officials at Harvard's Risk Management Foundation have developed a best practice manual that includes examples from across the system. One best practice was developed for following up on abnormal test results: The physician schedules a telephone appointment with a patient 1 week after a potentially concerning test. This forces the provider to find and review the results prior to the call, ensures that there will be some type of patient-physician discussion, and makes it easier to add the documentation directly into the medical record, Dr. Sato said.

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