Malpractice Claims Data as a Quality Improvement Tool

I. Epidemiology of Error in Four Specialties

by Richard L. Kravitz, John E. Rolph, Kimberly A. McGuigan

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This Note attempts to identify potentially preventable sources of medical injury in obstetrics and gynecology, general surgery, anesthesiology, and radiology. It is based on a retrospective review of physician malpractice claim records of a large New Jersey insurer of physicians practicing in those specialties during any portion of the period between 1977 and 1989. The authors examined the proportion of claims due to negligence associated with errors in (1) patient management, (2) technical performance, and (3) medical and nursing staff coordination, and considered the clinical and financial consequences of such errors. Among 1,371 claims ascribed to negligence, patient management errors were cited most frequently in all four specialties (48-75 percent) and, compared with performance and coordination problems, were generally associated with a higher frequency of serious injury and higher median payments. Coordination problems accounted for about 9 percent of claims. In obstetrics and gynecology, newborn delivery claims usually arose from management errors (57-68 percent), whereas gynecologic procedure claims were most often associated with performance errors (55-73 percent). Underperformance of cesarean section was cited more frequently than overperformance (31 percent vs. 3 percent). General surgery claims were about equally divided between management and performance types regardless of procedure. Failure to perform appropriate diagnostic testing or monitoring was the main problem in 3-8 percent of claims. The authors conclude that malpractice data can be used to identify problem-prone clinical processes and suggest interventions that may reduce negligence.

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