One could argue that the threat of malpractice liability improves the quality of care delivered to patients.

“Some patients and family say they pursued a malpractice claim specifically to ensure that poor care didn’t happen to someone else,” says Jestin Carlson, MD, FACEP, national director of clinical education for US Acute Care Solutions.

Data were lacking regarding the connection between litigation and subsequent improved quality of care in the ED. To learn more about this, researchers analyzed data from a national EP group practicing at 61 EDs in 11 states between 2010 and 2015.1 They assessed whether EP practice patterns changed after they were named in a malpractice claim, compared to unnamed physicians practicing in the same EDs.

Investigators included more than 6 million ED visits and 985 physicians in their analysis. Of this group, 72 EPs were named in 77 malpractice claims. The researchers studied admission rates; relative value units (RVUs), a commonly used metric to gauge physician productivity per hour and per visit; ED visit length; and Press-Ganey percentile ranking.

The data was examined retrospectively for all patients, for all patients for whom a malpractice lawsuit was filed, for malpractice claims alleging failure to diagnose, and for malpractice claims that did not include that specific allegation. The study authors did not examine specific clinical practice changes, such as whether the ED providers ordered more diagnostic tests after they were sued. “We looked at a large national group, but only at the macro level. We didn’t have ability to drill down and look at specifics of cases,” Carlson notes. Some key findings:

  • EPs who had been named in malpractice claims logged lower RVUs per hour than they did before they were named in the lawsuit. Since the study was a retrospective review, this does not necessarily prove causation. Thus, researchers cannot say for sure that the decreased productivity resulted from litigation. “We can only say it’s a correlation, but it looks like their practice tempo might be a little bit slower,” Carlson offers.
  • There was an immediate rise in satisfaction scores for EPs named in the 50 claims alleging failure to diagnose. The cause of this change is unknown. “But it would make sense that providers might slow down a little bit and take a little more time with the patient,” Carlson suggests.
  • Hospital admission rates were not linked to a plaintiff naming an EP in a lawsuit. This finding was somewhat surprising. “It would be reasonable to conclude that providers would become more conservative in admitting people to the hospital to avoid missing conditions. But that wasn’t borne out in the data,” Carlson says.

There are not much data to show how being a defendant in a malpractice claim affects EPs on a personal level. “We need to know more about the psychological and emotional impacts that it has on providers,” Carlson says.

EP defendants are not always aware of available support to help them deal with the stress and anxiety of litigation.

“Medical malpractice claims are not necessarily a reference of the quality of care someone provides,” Carlson notes.

REFERENCE

  1. Carlson JN, Foster KM, Black BS, et al. Emergency physician practice change in response to being named in a malpractice claim. Ann Emerg Med 2018;72:S9-S10.