Diagnosis mishaps main cause of litigation against hospitals


Failed, delayed, or wrong diagnosis, improper management of treatment, and medication-related error are the main triggers that lead patients to sue hospitals, according to a study by The Doctors Company.

The study of 464 claims against hospitalists insured by The Doctors Company underscores the particular risks hospitalists face because they treat patients with high acuity levels.

The research is based on the claims experience of more than 2,100 hospitalists from 2007 to 2014.

Researchers looked at all claims regardless of outcome, an approach that helps physicians and risk managers to better understand what motivates patients to sue hospitalists and to gain a broader overview of the system failures and processes that result in patient harm.

The analysis found that 78 percent of all claims against hospitalists included the three most common patient allegations: failed, delayed, or wrong diagnosis; improper management of treatment; and medication-related error.

"This study brings to light the particular challenges faced by hospitalists who manage high-acuity patients, have limited access to patients' past medical histories, and often receive patients with serious conditions," said Dr David Troxel, medical director, The Doctors Company.

"As the nation's largest physician-owned medical malpractice insurer, we are able to rigorously analyze the claims experience of our 78,000 members and translate these findings into industry-leading patient safety initiatives that protect physicians and their patients."

The research is unique because it includes insights from expert physicians into the specific factors that led to patient injury. The top factor, the physician reviewers determined, was inadequate patient assessments, which occurred in 35 percent of cases. This included failure to establish a differential diagnosis, failure or delay in ordering diagnostic tests, and failure to consider available clinical information. Also included in the study are examples of actual malpractice cases and suggested risk mitigation strategies.

"Through this study, hospitalists are made aware of rare diseases and conditions that can be missed - such as spinal epidural abscesses, which are historically uncommon but are now being seen more often in claims against hospitalists," said Dr John Nelson, medical director of the hospitalist practice at Overlake Hospital in Bellevue, Washington, and national expert on hospital medicine practice management.

"The study is extremely useful in providing risk mitigation strategies, such as pointing out the recognized patterns for rare diseases and suggesting steps to take to avoid an adverse outcome."

The Doctors Company, Dr David Troxel, US