Insights From 10 Years of Malpractice Claims Data: Part V

Malpractice data looks to the past and provides us with rich signals as to where patient care and provider exposure to claims remain vulnerable in today’s healthcare settings. Areas of concern can be quickly prioritized if data shows issues that led to preventable adverse outcomes still exist. But concurrently, we must always keep our eye on emerging risks. Problem areas we see surfacing are related to new technology, novel procedures, and current events that are developing at a rapid pace. 

This article highlights the following emerging risks: urgent care and minute clinics, electronic health records (EHRs), and robotics.
 

Urgent Care 

For the period covered in this report, urgent care or express care events are relatively new, comprising just 1% of closed event data and 1% of indemnity. Event counts and average indemnity paid are rising and are expected to grow over the next 10 years as the numbers of urgent care facilities expand.

The most frequent and costly allegation for events occurring in an urgent care setting is diagnosis-related. Average indemnity for events in urgent care settings is rising, with large fluctuation from year to year.

Most injuries are low or medium severity, but the combination of death and high-injury severity events accounts for 22% of events and is responsible for 86% of indemnity. Despite the low number of cases, this is an area that we will be closely monitoring over the next few years.

Top Risk Management Issues with Urgent Care 

Issues related to patient assessment and diagnosis accounted for 77% of clinical judgment risks. 


 

Electronic Health Records 

Diagnostic-related allegations comprise both the highest percentage of events as well as the highest indemnity payments in electronic health record-related (EHR) events. Total indemnity payout for diagnosis-related EHR events is $11 million more than for medication-related EHR events, which is the second-most financially severe allegation category.



The majority of EHR injury events were tied to medium-to-low severity injuries (59%). However, over half of the total indemnity dollars paid out on EHR events were attributed to events that resulted in death.



In theory, EHRs provide better data as well as a centralized capture of information relevant to a patient’s clinical profile. However, serious issues are evident. Users may be looking at the wrong dropdown, the wrong screen. The information might not have been updated, or the documentation may have done on the wrong patient.

Documentation is the most common risk management subcategory for EHR events, making up 72% of all EHR-related risk issues. In practice, patient assessment questions do not necessarily follow the EHR interface prompts so some information may be missed. Other prevalent risk areas include system issues such as confusing system design and incorrect patient information due to a system conversion and general EHR usability. HIPAA security issues made up approximately 2% of all EHR-related risk management factors.

Advanced Practice Providers 

With the decreasing number of physicians, advanced practice providers (APPs) are assuming an increasingly central role in patient care which opens the door to increased opportunities for success and failure. APPs include nurse practitioners, physician assistants, certified nurse midwives, and certified registered nurse anesthetists.

From 2010-2019, there are relatively few events involving APPs, but the count is rising. That trend is expected to continue as the population of APPs grows. An examination of claims involving 690 of these providers gives us some insights into issues relevant to APPs.

Allegations are strongly diagnosis-related, specifically involving patient assessment and ordering of diagnostic or lab tests. Issues related to the patient assessment process are persistent across a range of APPs.



Average indemnity paid for APP events was $440,116. Expenses are progressing upward and averaged $39,260. Rate of claims with indemnity paid was 25%. 



For more information about the existing risks related to urgent care, EHRs, and APPs, please refer to pages 29-32 within A Call for Action: Insights From a Decade of Malpractice Claims.