EXECUTIVE SUMMARY

One in 11 EPs was named in malpractice claims during a 4.5 year period, according to a recent study. Total number of years in practice and visit volume were the only factors associated with being named as a defendant. The researchers conclude that:

  • the study needs to be conducted in other databases to validate the findings;
  • continuing education should go on well beyond residency;
  • more data are needed about how EPs are affected by being named in a lawsuit.

One in 11 EPs was named in malpractice claims during a 4.5 year period, according to a recent study.1 Researchers analyzed more than 9 million ED visits involving 1,029 EPs. There were 98 malpractice claims against 90 physicians. “Our intent was to give EPs some idea of what factors are related to being involved in a malpractice suit, that may or may not be within their control,” says Jestin Carlson, MD, the study’s lead author. Carlson is national director of clinical education at US Acute Care Solutions.

Jesse M. Pines, MD, MBA, MSCE, another of the study’s authors, says, “Understanding physician and facility factors associated with malpractice claims is an important question, and one we thought would interest a wide audience.”

Claims carry significant economic and personal consequences for EPs, facilities, and patients, notes Pines, an associate professor in the departments of emergency medicine and health policy at George Washington University.

The researchers included many different variables in their analysis. Some were suggested by previous data to be related to malpractice litigation, while others were connected only anecdotally. The study authors examined years in practice, emergency medicine board certification, visit admission rate, relative value units generated per hour, total patients treated as attending physician of record, working at multiple facilities, working primarily overnight shifts, patient experience data percentile, and state malpractice environment.

“We did not know, going in, which factors would be related. Given the undifferentiated patient population and unique nature of emergency medicine, we wanted to better understand what those factors are,” Carlson explains.

The researchers hypothesized that many factors would contribute to malpractice risk, particularly patient satisfaction scores and board certification. They also expected that some facilities would be more litigation-prone than others.

“None of these ended up being important,” Pines says. Only these two factors were linked:

  • Physician age, with older age increasing malpractice risk. “This was a surprise, because conceptually physicians should be able to reduce their risk as they age, with greater experience and expertise,” Pines offers.
  • The number of cases seen. “This makes sense, because one would expect the likelihood of a rare event would be related to the exposure time,” Pines notes.

Although jurisdiction was not related, the data didn’t completely evaluate all the relevant factors. “There’s a lot more that goes into the practice patterns in those areas that we were not able to fully evaluate,” Carlson says. “It will require more work to tease out the factors that could be related to jurisdiction.”

The same is true for patient satisfaction scores. “It doesn’t mean the patient experience is not important. Certainly, it is a tremendous part of what we do,” Carlson says. “But in our data set, it was not linked.”

Since Press Ganey scores involve patients who are discharged, these aren’t necessarily representative of the patient population who gets admitted to the hospital. “There is also significant month-to-month variability in scores,” Carlson adds.

Although the median patient satisfaction scores did not differ in the two groups of EPs — those named in malpractice lawsuits, and those who were not named — the range of scores varied widely. The interquartile range was 25 to 90 for EPs who were not named, and 30 to 90 for those who were named. This makes interpreting its value challenging. “There may be other relationships with Press Ganey that we were not able to find in our data,” Carlson says. “But we did not find it was related to being named in a malpractice suit.”

The researchers studied relative value units generated per hour as a marker of the EPs’ tempo and the complexity of patients they were seeing. They found it wasn’t related to malpractice risk, either. “We were intrigued that more factors under the provider’s control were not related,” Carlson says.

Pines believes the study must be conducted in other databases to ensure that the findings are not unique to the researchers’ data.

“If it is truly validated, I think we need to think carefully about how we administer continuing medical education in emergency medicine,” Pines says.

For individual EPs, Pines stresses that it is important to focus efforts on continuing education well beyond residency, with a particular focus on high-risk topics that could lead to malpractice claims.

Carlson would like to see more data on how being named as a defendant in a malpractice claim affects an individual EP’s practice. “As we see in our data, many will be involved in a malpractice lawsuit during their career. These rates go up as years of practice and number of patients seen increase.”

There are still a lot of unknowns surrounding ED malpractice claims. It’s unclear, for instance, why certain cases result in litigation and others do not. “We did not have the granularity to provide that type of analysis,” Carlson laments. “Future work is needed looking at the why of malpractice suits being brought forward.”

REFERENCE

  1. Carlson JN, Foster KM, Pines JM, et al. Provider and practice factors associated with emergency physicians being named in a malpractice claim. Ann Emerg Med 2017 Jul 26. pii: S0196-0644(17)30786-2. doi: 10.1016/j.annemergmed.2017.06.023. [Epub ahead of print].

SOURCES

  • Jestin Carlson, MD, National Director, Clinical Education, US Acute Care Solutions, Canton, OH. Phone: (814) 452-5601. Email: jcarlson@ahn-emp.com.
  • Jesse M. Pines, MD, MBA, MSCE, Associate Professor, Departments of Emergency Medicine and Health Policy, George Washington University, Washington, DC. Phone: (202) 994-4128. Email: pinesj@gwu.edu.