Information on the types and causes of medical malpractice claims may help to reduce legal malpractice risk and inform patient safety efforts. Research has shown that the most common medical malpractice allegations include missed and delayed diagnoses and medication‐ and treatment‐related injuries and that an estimated 22%–56% of claims receive payment. However, no published research exists on the types and outcomes of medical malpractice claims made against hospitalists in the United States. We sought to identify the types, contributing factors, and outcomes of liability claims against hospitalists.
We conducted a retrospective observational analysis. Using a medical liability carrier–maintained database of more than 30,000 closed claims covering all medical specialties (and including academic medical centers, community hospitals, and private physician groups across the United States), we identified the claims in which a hospitalist was the attending of record. We analyzed these claims to ascertain the main allegation, contributing factors, and outcomes.
We identified 272 claims; these claims covered the period from 1997 to 2011. The mean age of the claimants was 56 years (SD, 22 years). Claimants were 51.8% female and 44.5% male (data not available for 3.7%). The most common claims were related to allegations of errors in medical treatment (n = 113, 41.5%), diagnosis (n = 98, 36.0%), and medication use (n = 26, 9.6%); see Table 1. The most common factors contributing to the claims were issues relating to clinical judgment (n = 148, 54.4%), communication (n = 99, 36.4%), and documentation (n = 53, 19.5%); see Table 2. Payment was made on 32.0% (n = 87) of all claims. The mean payment amount on the claims paid was $367,863.
The types of liability claims asserted against hospitalists appear to be generally similar to claims for all physicians, suggesting that hospitalists may not be subject to different types of legal risk compared with other physicians. Efforts directed at supporting and improving clinical judgment and communication may potentially reduce the liability risk for hospitalists.
|Allegation||No. of Cases||% of Cases||Definition orEexample|
|Error in medical treatment||113||41.5||Improper management or treatment course; failure to treat or a delay in treatment|
|Missed or delayed diagnosis||98||36.0||Failure to order a diagnostic test|
|Medication-related error||26||9.6||Incorrect medication regimen; ordering the wrong medication or wrong dose of medication|
|Inadequate monitoring||12||4.4||Inadequate monitoring of patient's physiological status|
|Error in surgical treatment||9||3.3||Error in management during or after surgery|
|Contributing factor||No. of Cases||% of Cases||Definition or Example|
|Clinical judgment||148||54.4||Problems with patient assessment or choice of therapy; failure/delay in obtaining consult/referral|
|Communication||99||36.4||Issues with communication among clinicians or between the clinicians and the patient or family|
|Documentation||53||19.5||Insufficient or lack of documentation|
|Administrative||47||17.3||Problems with staffing or hospital policies and protocols|
|Clinical systems||44||16.2||Failure or delay in scheduling a recommended test or failure to identify the provider coordinating care|
|Patient adherence||28||10.3||Patient not following provider recommendations; seeking other providers due to dissatisfaction with care|
|*An individual case may have multiple contributing factors.|
To cite this abstract:Schaffer A, Raman S, Puopolo A, Kachalia A. Medical Malpractice: Causes and Outcomes of Claims Against Hospitalists. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 517. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/medical-malpractice-causes-and-outcomes-of-claims-against-hospitalists/. Accessed April 25, 2019.