Separate reports indicate that nurses and hospitalists are being sued for malpractice more than in the past.

Malpractice claims against nurses are increasing, with more than $90 million paid in nurses’ malpractice claims over a five-year period, according to a report from the Hatboro, PA-based Nurses Service Organization (NSO), which provides malpractice insurance to nurses.

Of the 549 nurse closed claims:

• 88.5% involved RNs;
• 11.5% involved licensed practical nurses (LPNs) or licensed vocational nurses (LVNs).

These percentages were in proportion with the types of nurses insured by NSO.

Claims asserted against LPNs/LVNs resulted in a 58% increase in the average total incurred, compared with the NSO 2011 closed claim report. The higher severity was driven by several closed claims that settled for $250,000 or more and involved infant and pediatric patients with tracheostomies.

Nurses trained outside of the United States were more likely to be involved in a claim, but the average paid indemnity for foreign-trained nurses is almost half of that paid for those trained domestically. Nurses with additional certifications who worked in high-risk areas also were more likely to be sued:

• adult medical/surgical field, 36.1%;
• aging services, 16.4%;
• home health/hospice, 12.4%.

The highest average paid indemnity, $175,500, was for nurses working in the aesthetics/cosmetics fields. Next was obstetrics nurses’ indemnities, which averaged $141,661.

Most of the malpractice claims involved the death of a patient. Almost 85% of the nurses who experienced a claim had been in practice for at least 16 years, but those with the largest indemnity payments had been practicing for only three to five years.

The NSO report is available online at http://tinyurl.com/hcqwfgn.

CHALLENGE OF HIGH ACUITY

A study of 464 claims against hospitalists insured by The Doctors Company, a malpractice insurer based in Napa, CA, underscores the particular risks that 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% 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.

The 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 David B. Troxel, MD, medical director of The Doctors Company in a statement accompanying the report. Troxel said the research is unique because it includes insights from expert physicians into the specific factors that led to patient injury.

MOST SIGNIFICANT FACTOR

The top factor, the physician reviewers determined, was inadequate patient assessments, which occurred in 35% of cases. The inadequate assessments 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.

Hospitalists should be on the lookout for rare diseases and conditions that can be missed, such as spinal epidural abscesses, which are historically uncommon but now are being seen more often in claims against hospitalists, the report says.

The study is available at http://tinyurl.com/hcgn9xw.