More than half the allegations filed against hospitals due to emergency department care come from cases where there is a delay or failure to make a diagnosis, according to a new report from medical professional liability insurance provider Coverys.
The Boston-based insurance provider analyzed more than 1,300 emergency department-related closed medical professional liability claims across the five-year period between 2014 and 2018. Examining the root causes of claims occurring in the ED, delay of diagnoses—including the lack of an appropriate patient/family history and physical as well as the inappropriate ordering of diagnostic tests—was among the greatest vulnerability during the emergency department episode of care.
"The ED is a really unique environment. They don't have the luxury of having multiple visits with patients where they get to know the patient, where they can really think about the diagnosis in a non-urgent type of a situation, Ann Burke, who is the director of risk management at Coverys and a lead author on the report, told FierceHealthcare. "Basically they have one chance to get it right."
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That means, healthcare providers are going to do a focused evaluation and physical that is complaint-driven given the circumstances surrounding that patient's presentation to get to that diagnosis as quickly as possible, either ruling out or confronting critical or life-threatening needs, she said.
According to the report, about half of the diagnosis-related allegations identified the point at which they were most vulnerable was at the initial history and physical and a quarter of those claims involved the ordering of a diagnostic test.
Cardiac and cardiovascular conditions — such as heart attacks, aortic aneurysms, aortic dissections or ruptures —triggered the most ED-related liability claims, Burke said. Infections, including sepsis, meningitis and pneumonia were also areas that trigger more ED-related claims, she said.
"Those are areas where organizations, leadership, the ED department can really start their focus on that part of the patient safety movement," Burke said.
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The report also found:
- 32% of malpractice allegations in the ED involve permanent injuries and 38% involve grave injury or death.
- 56% of ED claims involve allegations of diagnostic error, while 20% of ED claims allege an issue with the medical treatment itself.
- 44% of diagnosis-related ED claims allege failure during the initial history and physical evaluation stage, while 27% of diagnosis-related ED claims involve issues related to ordering diagnostic/lab tests.
- 49% of medication-related allegations in the ED involve three types of drugs: antibiotics, opioids and anticoagulants.
- 44% of ED-related claims cited clinical judgment as a factor.
To reduce diagnostic risks in the emergency department, the report recommends practitioners focus on three key areas including history and physical examination, the diagnostic decision-making process and ensuring the patient evaluation is ongoing throughout the ED episode of care.
"We believe our signal data provides guidance and insight into patient safety and we would urge and encourage all to look at the signals and take action within their organizations," Burke said.